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.

ER visits rise because of prescription drug abuse

Medications
July 17, 2010

by Michael Smith

The number of emergency room visits for nonmedical use of prescription painkillers more than doubled between 2004 and 2008, according to a CDC estimate.

The increase was part of a trend that saw emergency room visits for nonmedical use of all prescription and over-the-counter medications reach the same level as those for abuse of illicit drugs, the agency said in the June 18 issue of Morbidity and Mortality Weekly …

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ER visits rise because of prescription drug abuse

Rosiglitazone (Avandia) stays on the market, with stronger warnings

Medications
July 14, 2010

by Emily P. Walker

An advisory panel voted 20-12 to recommend that the FDA allow rosiglitazone (Avandia) to stay on the market, but most panelists want to see the controversial diabetes drug carry tougher warnings on its label.

Wednesday’s vote marks the second time an FDA advisory panel has essentially endorsed rosiglitazone. In 2007, a panel voted that while the drug appears to …

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Rosiglitazone (Avandia) stays on the market, with stronger warnings

Ecstasy overdose is becoming more frequent at rave parties

Medications
July 13, 2010

by Crystal Phend

Overdoses of the “club drug” ecstasy at all-night rave dance parties may be a rising but under-reported public health problem, the CDC said.

What may be the first public health investigation into the epidemiology of ecstasy overdose revealed that 18 patients landed in hospital emergency departments for illness related to the hallucinogenic stimulant within 12 hours after a Los Angeles New Year’s Eve rave.

This cluster of events was accompanied …

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Ecstasy overdose is becoming more frequent at rave parties

Will Avandia survive the FDA advisory panel?

Medications
July 13, 2010

by Crystal Phend and Emily Walker

Despite hints that the FDA may be leaning toward pulling rosiglitazone (Avandia) from the market, it’s going to be a tough decision for the advisory committee slated to begin meeting on Tuesday, and things could still go either way, leading endocrinologists predict.

“I think the FDA advisory committee is going to struggle with this because none of the data is conclusive,” …

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Will Avandia survive the FDA advisory panel?

Is health care experience mandatory for a pharmaceutical CEO?

Medications
July 11, 2010

A persistent theme for Health Care Renewal has been how concentration and abuse of power in health care trap patients and heath care professionals in a maze of bureaucracy, perverse incentives, deception, and conflicts of interest.

To anyone who has to make the transition from person to patient, some of these problems become immediately obvious.

Consider, for example, this account of “going into a hospital for a minor procedure”:

The very idea of …

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Is health care experience mandatory for a pharmaceutical CEO?

Be skeptical of natural and herbal supplements

Medications
July 10, 2010

A good chunk of every medical visit is spent writing prescriptions.

Before we had an electronic medical record, this was often an arduous task, leading to serious writer’s cramp. Now the computer makes it easier on the doctor, but it doesn’t seem to have much effect on the patient.

A recent article in the Journal of General Internal Medicine highlighted what most doctors have suspected all along, that a good chunk for …

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Be skeptical of natural and herbal supplements

Linezolid resistant Staphylococcus aureus (LRSA) emerging

Medications
July 10, 2010

by Kristina Fiore

The first known outbreak of linezolid and methicillin-resistant Staphylococcus aureus (LRSA) occurred during a 13-week period in 2008 in a hospital in Madrid, researchers say.

The LRSA outbreak, involving 12 patients in the hospital’s intensive care unit (ICU), was also the first with cfr gene-mediated linezolid resistance and was associated with nosocomial transmission and prior administration of linezolid, Miguel Sanchez Garcia, MD, PhD, of Hospital Clinico San Carlos in …

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Linezolid resistant Staphylococcus aureus (LRSA) emerging

Combo pills do not save patients money

Medications
July 7, 2010

Many prescription medicines are actually two or more medicines combined into one pill or package. True, this packaging is convenient– but you can often save money by buying your medicine as its separate components. Let’s look at some examples:

Lotrel blood pressure pills. This is actually a combination of two blood pressure medicines: amlodipine and benazapril. Lotrel, the combo pill, is available in a generic form, as are it’s two individual …

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Combo pills do not save patients money

Abuse of prescription drugs starts in high school

Medications
June 29, 2010

by Todd Neale

One high school student in five has taken a prescription drug without a doctor’s order, according to a nationwide survey.

Abuse of a prescription drug was most common among white students (23%), followed by Hispanics (17.2%) and blacks (11.8%), according to Danice Eaton, PhD, of the CDC’s Division of Adolescent and School Health in Atlanta, and colleagues.

Improper use increased steadily from ninth grade (15.1%) to 12th grade (25.8%). Girls …

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Abuse of prescription drugs starts in high school

When patients don’t take their prescription drugs

Medications
June 28, 2010

One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes.

Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as “non-compliant,” “against medical advice” and expressing wonderment why …

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When patients don’t take their prescription drugs

American cigarettes contain more carcinogens

Medications
June 27, 2010

by Todd Neale

Levels of tobacco-related nitrosamines — known carcinogens produced when curing tobacco — are higher in popular brands of American cigarettes compared with those from other countries, potentially leading to more cases of lung cancer, researchers found.

The study of 126 smokers in four countries found that exposure to one carcinogen — 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) — was highest among those from the U.S. compared with smokers from England, Canada, and Australia, …

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American cigarettes contain more carcinogens

Injectable heroin or methadone for addiction treatment

Medications
June 23, 2010

by Charles Bankhead

Heroin addicts had almost a threefold increase in negative urine specimens when treated with supervised heroin injection rather than with oral methadone, data from a British study showed.

Overall, 72% of patients had negative specimens at least 50% of the time compared with 27% of patients assigned to oral methadone, according to the report published in the May 29 issue of The Lancet.

Treatment with injectable heroin almost doubled the …

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Injectable heroin or methadone for addiction treatment

Citalopram and other SSRI drugs can reduce hot flashes

Medications
June 21, 2010

by Charles Bankhead

Hot-flash frequency and severity declined by 50% in postmenopausal women treated for six weeks with the antidepressant citalopram, according to data from a placebo-controlled, randomized clinical trial.

The trial, conducted among 254 women with frequent hot flashes (at least 14 hot flashes a week for a month or longer), found that the lowest of three citalopram doses was as effective as the highest for dousing hot flashes, but the …

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Citalopram and other SSRI drugs can reduce hot flashes

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C. Diff and how dentists overuse antibiotics

Medications
June 20, 2010

Why do dentists prescribe antibiotic prophylaxis so often?

Because they can.

Why am I dissing my dental colleagues? Because I can.

Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals:

• Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold
• …

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C. Diff and how dentists overuse antibiotics

Fracture risk with Prilosec and other proton pump inhibitors

Medications
June 19, 2010

The FDA released a Drug Safety Communication warning about a possible risk of increased fractures with acid blocking medications called proton pump inhibitors or PPIs.

PPIs have been a major advance in medical science. Prior to these and earlier medications, the treatment for severe gastroesophageal reflux disease (GERD) was major surgery. PPIs are now commonly prescribed for GERD and less serious heart burn, many are generic, and some are now sold …

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Fracture risk with Prilosec and other proton pump inhibitors

Multiple vaccines in infants are harmful, a theory disproved

Medications
June 16, 2010

by John Gever

Worries that cramming multiple vaccinations into the first months of life slows brain development have no basis in fact, researchers said.

There was no evidence of neurodevelopmental delays or deficits associated with on-time vaccination in an intensively studied cohort of more than 1,000 children, according to Michael J. Smith, MD, and Charles R. Woods, MD, of the University of Louisville, in the June issue of Pediatrics.

“These data may reassure …

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Multiple vaccines in infants are harmful, a theory disproved

Prescription drugs and its copycats contribute to health waste

Medications
June 14, 2010

I’ve recently posted about the insane costs of health care, and about how defensive medicine is a big contributor. Prescription drugs are another huge cost, accounting for about 11% of the 2 trillion spent each year on health care in The United States. And it turns out that the marketplace for prescriptions is also rife with bizarre sources of waste and sneakery.

First, some good news: prescription medications are …

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Prescription drugs and its copycats contribute to health waste

Statins do not decrease the risk of many cancers

Medications
June 14, 2010

by Kristina Fiore

Claims of unintended benefits of statins appear to be largely unsubstantiated and known risks — including liver and renal problems and myopathy — confirmed, British researchers concluded based on findings from a large prospective open cohort study.

The study involving more than two million people, “largely confirmed other studies that reported no clear association between statins and risk of cancers,” Julia Hippisley-Cox, MD, and Carol Coupland, MD, of the …

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Statins do not decrease the risk of many cancers

Ask your pharmacy to price match prescription drugs

Medications
June 12, 2010

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another.

But did you know that some pharmacies will actually match a competitor’s price? This could save you a ton of cash, but you have to know how, and whom, to ask for this service. Pharmacy retail chains all have different policies. I spoke to a pharmacist recently at each of the seven top …

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Ask your pharmacy to price match prescription drugs

Primary care antibiotic resistance for common infections

Medications
June 10, 2010

by Nancy Walsh

Primary care patients prescribed an antibiotic for a urinary tract or respiratory infection consistently developed resistance to that antibiotic lasting as long as one year, a British meta-analysis revealed.

In five studies that included 14,348 patients treated for urinary tract infections, within one month of receiving an antibiotic an individual patient’s odds ratio having a resistant pathogen was 4.40 (95% CI 3.78 to 5.12), according to Céire Costelloe, PhD, …

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Primary care antibiotic resistance for common infections

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