October 2014 -- People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar according to a new study.

From those started on metformin, only about one-quarter needed another drug to control their blood sugar. However, people who were started on type 2 diabetes drugs other than metformin often needed a second drug or insulin to control their blood sugar levels.

For the current study, data on more than 15,000 people was collected from July 2009 to June 2013. The average follow-up time was slightly longer than one year. Of those patients, almost 60 percent were initially treated with metformin, and about one-quarter began treatment with a sulfonylurea, according to the study. Just 6 percent were started with a thiazolidinedione, and 13 percent with a DPP-4 inhibitor.

Around 40 percent of people taking a sulfonylurea, a thiazolidinedione, or a dipeptidyl peptidase 4 inhibitor (DPP-4 inhibitor) added a second drug to their diabetes treatment regimen during the study. Just 25 percent of those on metformin added an additional oral drug during the study period.

In addition, 5 percent of those started on metformin later added insulin to their treatment, according to the study. About 9 percent of those who started on a sulfonylurea, 6 percent started on a DPP-4 inhibitor and 6 percent started on thiazolidinediones, also took insulin.

 

Reference
Berkowitz SA, Krumme AA, Avorn J, Brennan T, Matlin OS, Spettell CM, Pezalla EJ, Brill G2, Shrank WH, Choudhry NK. Initial Choice of Oral Glucose-Lowering Medication for Diabetes Mellitus: A Patient-Centered Comparative Effectiveness Study. JAMA Intern Med. 2014 Oct 27.


 

October 2014 -- A child receives the wrong medication or the wrong dosage every eight minutes in the United States, as per a recent study.

Nearly 700,000 children under 6 years old experienced an out-of-hospital medication error between 2002 and 2012. Out of those episodes, one out of four children was under a year old. As the age of children decreased, the likelihood of an error increased. Though 94 percent of the mistakes didn't require medical treatment, the errors led to 25 deaths and about 1,900 critical care admissions.

The reasons for errors included giving repeat doses, incorrectly measuring the dosage or over-prescription of some medications. Eight of every 10 errors involved liquid medication. Young children are more likely to be given liquid medicine than medicine in other forms, like tablets or capsules. Also liquids can be difficult to measure correctly. Using teaspoons or tablespoons to administer was behind many drug dosing errors. 

In this study, errors involving cough and cold medicines suddenly dropped by two-thirds from 2005 to 2012. This is because of 2 reasons. In 2007, the U.S. Food and Drug Administration announced that it was reviewing the safety of over-the-counter cough and cold medicines for children, and soon after, manufacturers voluntarily withdrew those drugs from shelves for children under 2 years old. Shortly thereafter, the American Academy of Pediatrics said that cough and cold medicines weren't effective in children under 6, and that those medications might pose a health risk to young children.

Pain relievers and cough and cold medicines each comprised about a quarter of all the errors identified, and antihistamines made up 15 percent of the errors. Antibiotics made up about 12 percent.

The message from this study for parents is that children do not routinely require medications for fever, congestion or the common cold. Decreasing use of the medications may lead to fewer errors.

 

Reference

Smith MD, Spiller HA, Casavant MJ, Chounthirath T, Brophy TJ, Xiang H. Out-of-Hospital Medication  Errors Among Young Children in the United States, 2002-2012. Pediatrics. 2014 Oct 20. [Epub ahead of print]

 

 

 

October 2014 -- Drugs commonly used to treat Parkinson's disease may raise the risk of so-called impulse control disorders, according to a new review. These disorders include compulsive gambling, compulsive shopping and/or hypersexuality. Dopamine receptor agonists are widely used to treat a range of illnesses, including Parkinson's, restless leg syndrome and hyperprolactinemia.

To explore any risk for the development of impulse control issues, the study authors analyzed FDA data on 2.7 million domestic and foreign adverse drug events reported between 2003 and 2012.

Of these, 1,580 events were specifically identified as involving what investigators categorized as "serious" impulse control scenarios, with about half involving American patients. The remaining cases involved patients in 21 other countries.

Nearly 45 percent of these events (710) were linked directly to the use of any of six different dopamine receptor agonist medications, with most involving male patients (more than 65 percent) at an average age of 55. The other 55 percent of cases were associated with the use of other medications.The team identified 628 instances of pathological gambling, 465 cases of hypersexuality, and 202 examples of compulsive shopping.

The problem is that there is a lot of underreporting of these problems . The doctors should help patients be more open on these issues.

 

References

  1. Moore TJ, Glenmullen J, Mattison DR. Reports of Pathological Gambling, Hypersexuality, and Compulsive Shopping Associated With Dopamine Receptor Agonist Drugs. JAMA Intern Med. 2014 Oct 20.[Epub ahead of print]
  2. Gendreau KE, Potenza MN. Detecting associations between behavioral addictions and dopamine agonists in the Food & Drug Administration's Adverse Event database. J Behav Addict. 2014 Mar;3(1):21-6.

September 2014 --Metformin, a drug commonly used to treat diabetes, may raise the risk of low levels of thyroid-stimulating hormone (TSH) among patients with an underactive thyroid as per a new study. The researchers cautioned that low TSH levels may be associated with heart problems and broken bones, although a cause-and-effect link was not established.

Among those in the study with an underactive thyroid (hypothyroidism), there were 495 incidences of low levels of thyroid-stimulating hormone per year compared with 322 in the normal thyroid group. Among patients treated for an underactive thyroid, metformin was linked with a 55 percent higher risk for low TSH levels, compared to those who were taking sulfonylurea for their diabetes.

The question this study poses is: does the suppressed TSH have clinical significance? Millions of people have type 2 diabetes and millions of people have low thyroid and take thyroid pills. And given the multiple millions of people who take both drugs there has been no mass clinical issue till now. Also, "this study did not contain any measurements of the two forms of thyroid hormone in the blood. That data might help clarify why the TSH is suppressed.

The reason for metformin's effect on TSH levels is not clear at present. It is also unclear whether the low TSH levels associated with metformin in this study put patients at risk for developing other complications such as cardiovascular diseases. But physicians need to consider this possibility in their routine practice.

 

Reference:

Fournier JP, Yin H, Yu OH, Azoulay L. Metformin and low levels of thyroid-stimulating hormone in  patients with type 2 diabetes mellitus. CMAJ. 2014 Sep 22. 

 

September 16, 2014 -- The U.S. Food and Drug Administration approved Movantik (naloxegol), an oral treatment for opioid-induced constipation in adults with chronic non-cancer pain.

Opioids are a class of drugs that are used to treat and manage pain. A common side effect associated with the use of these drugs are that they reduce the gastrointestinal tract’s motility, making bowel movements difficult and causing patients to strain, have hard or lumpy stools or experience a sensation of incomplete evacuation. Movantik belongs to a class of drugs called peripherally acting opioid receptor antagonists, which are used to decrease the constipating effects of opioids.

Movantik’s safety and effectiveness were established in two clinical trials of 1,352 participants who had taken opioids for at least four weeks for non-cancer related pain and had opioid-induced constipation. Participants were randomly assigned to receive 12.5 mg or 25 mg of Movantik or placebo (sugar pill) once daily for 12 weeks. 

Common side effects of Movantik include abdominal pain, diarrhea, headache and flatulence.