Medications and Prescribing

Physicians writing on KevinMD about prescribing: the prior authorization that stands between a prescription and a pharmacy, opioids and the tapers that followed the CDC guideline, GLP-1 drugs and what happens when patients stop them, compounded and direct-to-consumer drugs, shortages, and what a prescription costs the patient. Three maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

American cigarettes contain more carcinogens

MedPage Today

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, …

Injectable heroin or methadone for addiction treatment

Charles Bankhead

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 …

Citalopram and other SSRI drugs can reduce hot flashes

Charles Bankhead

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 …

C. Diff and how dentists overuse antibiotics

Michael Kirsch, MD

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
• …

Fracture risk with Prilosec and other proton pump inhibitors

Matthew Mintz, MD

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 …

Multiple vaccines in infants are harmful, a theory disproved

MedPage Today

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 …

Prescription drugs and its copycats contribute to health waste

Roy Benaroch, MD

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 …

Statins do not decrease the risk of many cancers

Kristina Fiore

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 …

Ask your pharmacy to price match prescription drugs

Leslie Ramirez, MD

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 …

Primary care antibiotic resistance for common infections

MedPage Today

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, …

Demerol used to treat shivering in patients

Christian Sinclair, MD

Conditions and Diseases

June 9, 2010

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.

Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause biliary spasm, …

How drug information fine print fails to communicate

Steve Woodruff

Medications

June 6, 2010

As someone deeply immersed in pharma communications, and especially the newer realm of social networking, I’ve been closely following the ongoing process of the industry/FDA dance, trying to figure out how social media/web 2.0 approaches “fit” with pharmaceutical manufacturers and their various audiences.

And I keep wondering if we’re going about the whole thing the wrong way.

Think about the fine print PI (Product Information) you see in a magazine, accompanying a …

Cocaine and drug addiction from work exposures

Jan Gurley, MD

Medications

June 6, 2010

It’s hard to look at the mug-shot of the 60-year-old woman charged with tampering with forensic drug evidence (basically, stealing police-confiscated cocaine) without wondering how things got to this point. I mean, surely they weed out the felons, and the known addicts, and do a background check, and then make you pee in a cup before they even hire you for a job like this. Right?

So just exactly how can …

Doctors can report bad drug ads to the FDA

MedPage Today

Medications

June 4, 2010

by John Gever

A new FDA program seeks to enlist healthcare professionals in flagging improper sales tactics for prescription drugs.

Although the agency calls the program “Bad Ad,” its interest goes beyond broadcast and print advertisements to include misleading in-person presentations.

Housed within the Division of Drug Marketing, Advertising, and Communication (DDMAC), the program is intended to increase the number of eyes and ears available to monitor pharmaceutical companies’ promotional activities — especially …

Shingles vaccine and the price of preventive care

Shantanu Nundy, MD

Conditions and Diseases

June 3, 2010

They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.

Mr. GR, as I will call him, had recently turned 60 years young. Though he …

Proton pump inhibitors associated with fracture and C. difficile

Charles Bankhead

Medications

May 31, 2010

by Charles Bankhead

Proton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported.

PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50% over three years, but had no effect on the risk of hip fracture. Overall, the acid-fighters had a modest effect on bone mineral density (BMD), Seattle researchers reported in the May 10 …

Your asthma or COPD inhaler is not available, and what to do

Matthew Mintz, MD

Medications

May 28, 2010

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:

Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013

The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …

How primary care should manage chronic pain patients

Juliet K. Mavromatis, MD

Medications

May 28, 2010

In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …

Female sexual dysfunction treatment options

Jill of All Trades, MD

Conditions and Diseases

May 27, 2010

Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.

Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is …

Few receive the shingles vaccine because of cost to doctors

MedPage Today

Medications

May 26, 2010

by Michael Smith

It’s a classic good-news, bad-news story.

The vaccine against shingles, already shown to be effective, is both safe and well-tolerated, researchers found after following more than 38,000 participants in the randomized trial that led to the 2006 approval of the vaccine.

On the other hand, few people are getting the vaccine, and for a variety of reasons — including its cost — researchers noted in a separate study. Both analyses …

Medications and Prescribing

Medications and Prescribing

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