Tag Archives: antidepressants

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Can a Pill Prevent Breast Cancer? For Some Women, the Answer May Be Yes

By Jennifer L.W. Fink
Every morning, I swallow a little white pill in the hope that it will keep me from losing my breasts — or my life — to the disease that’s already taken so much from so many women in my family.

The drug is tamoxifen, a selective estrogen receptor modulator that reduces the effects of estrogen in most parts of the body. The disease I’m running from is breast cancer. And the hope is that this pill will alter my destiny. Breast cancer cells need estrogen to grow and tamoxifen works by blocking hormone receptors on those cells so that estrogen doesn’t attach to those receptors.

My maternal grandmother died of breast cancer. So did her mother. My mother and aunt are both alive and well, but not without significant pain and sacrifice. Both had breast cancer and lost both of their breasts. My mother developed ovarian cancer too, 10 years after she beat breast cancer.

That’s when I pushed for genetic testing, and when we learned that the cancer that plagues our family is likely due to inherited BRCA2 mutations. Women who have a BRCA2 mutation (one of the so-called “breast cancer genes”) have a 45% chance of developing breast cancer by age 70, compared to an approximately 8% risk for women in the general population, according to the National Cancer Institute. Women with a BRCA2 mutation also face a significantly higher risk of ovarian cancer — between 11% and 17% by the time they reach 70, compared to 1.3% for women in the general population.

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Email Us at share@medshadow.org

Weighing Removal of Breasts and Ovaries

I can decrease my risk of both breast and ovarian cancer by having those organs removed. That’s the choice Angelina Jolie famously made a few years ago. A test showed that Jolie had the BRCA1 mutation — which also greatly raises the risk of breast and ovarian cancers — and her mother, grandmother and aunt had all died from cancer.

I watched my mother go through her mastectomy and recovery, and know the process is far from pain-free. Plus, I like my breasts and my ovaries. They’re important components of my sexuality, health and well-being. I don’t want to surrender them if I don’t have to.

Ask Your Doctor About Chemoprevention If:

  • You have a strong family history of breast cancer
  • You have a known genetic mutation that increases your risk of cancer, such as BRCA1, BRCA2 or PALB2
  • You’ve ever had a breast biopsy
  • You’ve ever been diagnosed with atypical ductal hyperplasia (ADH)

But on the other hand, I see the devastation cancer treatment has wreaked on my mother’s body. Some days, it’s hard for her walk because chemotherapy damaged the nerves in her feet. Her lung problems are likely related to the many doses of radiation to her chest. I’d like to avoid all that too, if I can.

A 5-Year Course of Tamoxifen

So I swallow the white pill. I’m 1-1/2 years into a prescribed 5-year course of tamoxifen.

Chemoprevention, or the use of chemical agents to prevent cancer, is one option for women who are at high risk of developing breast cancer. Prophylactic, preventive surgeries — what Angelina Jolie chose — are another. Watching and waiting is yet another.

Chemoprevention is perhaps the option that is least widely discussed. According to a 2015 article in the New England Journal of Medicine, “even though the benefit-risk ratios for chemopreventive agents are favorable for many women… these agents are infrequently prescribed and infrequently used… Studies focusing on high-risk women show that many physicians are reluctant to prescribe these agents… Numerous other studies have documented the reluctance of women — even women who are considered high-risk — to take tamoxifen, mainly because of a fear of side effects.”

Chemoprevention Can Reduce Cancer Risk, But With Side Effects

Studies have shown that chemoprevention with either tamoxifen or raloxifene — the latter is also a selective estrogen receptor modulator — can decrease the risk of cancer by about half in high-risk women. But both drugs carry significant risks. Both drugs can cause menopausal symptoms, including hot flashes, night sweats, vaginal dryness and weight gain. Both also increase the risk of developing blood clots, and tamoxifen increases a woman’s risk of developing uterine cancer.

Shikha Jain, MD, an oncologist at Northwestern Memorial Hospital in Chicago, helps high-risk women weigh the pros and cons of chemoprevention. “In most breast cancer prevention studies, the overall risk of blood clots developing over the years of treatment was less than 1%,” she says. “Now, if you’ve had a serious blood clot in the past, your risk could be higher. In that case, we wouldn’t recommend chemoprevention.”

Similarly, for most women, the risk of developing uterine cancer as a side effect of chemoprevention is very low. “In one study of women who were on tamoxifen for up to 5 years, specifically to lower their risk of breast cancer, less than 1% of those women developed uterine cancer,” Dr. Jain says.

Still, the decision is not an easy one. Here, 2 women share their experiences with chemoprevention.

Laury Watts

Age: 39

Risk Factors: Family history of breast cancer and PALB2 mutation

On Tamoxifen: since May 2017

“Right off the bat, my oncologist threw tamoxifen at me. I was hesitant. I told her, ‘I don’t want it to ruin my bones.’ She was like, ‘Would you rather get cancer, or brittle bones?’ It was like she didn’t have any sympathy for me… I wavered for 2 months before I started taking it.”
Side Effects: Irregular periods, “stiffness in my bones”

The Doctor Says: “I typically recommend vitamin D and calcium supplementation in premenopausal women if there are no contraindications.” – Dr. Jain

Takeaway: “I feel like I shouldn’t have taken it. I felt fine. I didn’t have cancer. But I also understand that I’m lowering the risk as I’m taking it. I’m on it now, so I might as well stick it out.”

Kelly Miller

Age: 51

Risk Factor: Diagnosis of atypical ductal hyperplasia (ADH)

On Tamoxifen: for 2.5 years

“I started on the tamoxifen so I would feel like I was doing something. I didn’t have any other options except the preventive mastectomy.”

Side Effects: Decreased libido, hot flashes, insomnia, night sweats, increased emotional stability

The Doctor Says: “If patients are having severe symptoms that affect their lives on a day-to-day basis, we can use medications to help. Effexor (venlafaxine) is the one I use the most. It’s been shown to be very helpful with hot flashes.” – Dr. Jain

Takeaway: “It’s definitely scary, but isn’t it amazing that science can tell us that we are prone for a certain thing? At least we have the choice of whether or not to take a pill to try and fight it off.”

Overprescribing: Do You Really Need to Take That Med?

Do you take 4 pills a day? If so, you’re like most Americans. Yet what are we taking all these pills for, and are they improving our lives?

The overuse of prescription drugs has become a serious problem in the US. We hear about this most in the context of opioids — narcotic painkillers whose widespread use and abuse has become a national crisis.

The overuse of antibiotics has also become the focus of an intensive campaign to steer doctors and patients to more judicious use.

The soaring use of prescription drugs has been driven by several factors: A plethora of new drugs coming to the market; a culture that has come to expect a “pill for every ill”; aggressive marketing to both doctors and consumers by the pharmaceutical industry; and treating some “pre-”diseases with pills rather than with lifestyle changes.

Between 1997 and 2016, the number of prescriptions filled in the US increased 85% — from 2.4 billion to 4.5 billion — even though the population increased by just 21%. Nearly half (49%) of adults take at least 1 prescription drug, 23% take 3 or more and about 12% take 5 or more, according to the latest data from the CDC (Centers for Disease Control and Prevention). One in 10 adults takes 10 or more drugs, and the average adult takes 4 prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April.

What can you do to make sure you’re not getting a drug you don’t need and to avoid harm?

Ten “secret shoppers” were sent to 45 drugstores across the US in a recent Consumer Reports investigative study. The shoppers were testing how well pharmacists identified potential problems with drugs.

Of course, it’s your doctor who should be your main consultant on the medicines you take. But bring a big measure of skepticism to your doctor visits: The evidence is now clear that they can be a part of the problem.

Based on the secret shoppers’ findings and more than a decade of Consumer Reports’ grant-funded Best Buy Drugs program, we have compiled a list of drugs that you should use special caution with when prescribed by your healthcare provider.

(For more detailed information, check out Consumer Reports’ September 2017 cover story and the physician-led Choosing Wisely program.

Abilify and Seroquel for Dementia or ADHD

These powerful antipsychotics have potent sedative effects and can be downright dangerous. Studies over the last decade show they have been overprescribed in general and particularly for elderly people with dementia.

The FDA and other healthcare and physician organizations now advise against their use entirely in elderly people. Multiple studies over many years have found an increased risk of death in elderly people prescribed these drugs.

Abilify (aripiprazole) and Seroquel (quetiapine) are also overprescribed to treat children and adults with attention-deficit/hyperactivity disorder (ADHD). The two drugs are not even approved for this condition. Their use to treat ADHD is not advisable unless a person is diagnosed with other psychiatric conditions, such as bipolar disorder. And even then, caution is warranted. Behavioral therapy is a better initial treatment for ADHD.

Advil, Aleve, Celebrex and Any Opioid for Back and/or Joint Pain

The non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib) are commonly prescribed to treat back and joint pain (and headaches, of course). Short-term use — up to 10 days — is fine at the lowest dose that helps.

But long-term use — which is all too common — is ill-advised because all these drugs can cause bleeding in the intestines and stomach, and increase the risk of heart attack and stroke (especially at higher doses).

Opioids should simply never be a first-line treatment for either chronic back pain or garden-variety periodic back pain (“I threw my back out” kind of pain). The risks are too high. The side effects include drowsiness, sedation, nausea, vomiting, constipation, addiction and overdose. Instead, try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture or heat.

For intense pain flare-ups (pain in the range of 8 to 10 on a 10-point scale), an opioid can be useful, but it should be prescribed at the lowest dose that’s effective and for the shortest time possible, like a day or 2. And never more than a week to 10 days.

Celexa, Cymbalta, Lexapro and Prozac for Mild Depression

Antidepressants are overprescribed for people who have mild or so-called “situational” depression — that is, depression triggered by a life event such as a death in the family, job loss, divorce or breakup, accident, trauma or diagnosis with a serious health condition.

You don’t need a pill if these life events befall you. Social support, time and psychotherapy or counseling almost always help. Also, be sure to exercise and perhaps try meditation and/or yoga. For the vast majority of people who have situational depression, the symptoms lift within a few weeks to a couple months.

Nexium, Prevacid and Prilosec for Heartburn

These drugs, called proton-pump inhibitors (PPIs), reduce stomach acid. They were designed to treat a condition called gastroesophageal reflux disease (GERD). But they are greatly overprescribed for common, uncomplicated heartburn, which most of the time can be just as effectively treated with over-the-counter (OTC) products such as Maalox, Pepcid AC, Tums or Zantac 75.

The problem with taking PPIs is that they carry serious risks — a few of which were not fully appreciated until a few years ago. These include a reduction in the body’s ability to absorb certain nutrients and medications, along with an increased risk of gastrointestinal and other infections.

Instead, as a first-line treatment, eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid acidic or greasy meals that trigger heartburn.

If heartburn occurs twice weekly or more for 4 weeks or longer despite the above diet and lifestyle changes, then you might have damaged your esophagus. Check with your doctor, and if GERD is diagnosed, it would be appropriate to take a PPI for a few months while your esophagus heals.

Ambien, Belsomra and Lunesta for Insomnia

These strong sleeping pills are way overprescribed for people who have insomnia triggered by a life event, as well as for people who have chronic insomnia.

If you find yourself in the first group, try an OTC sleep aid containing an antihistamine, but not for longer than a few days. People with chronic insomnia are not helped in the long term by taking these medicines, recent evidence shows. Instead, try cognitive behavioral therapy (CBT), where a provider teaches you good sleep habits and suggests ways to change your behavior and nighttime habits.

Prescription medicines have significant side effects and risks, including dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

AndroGel, Axiron, Androderm and Aveed for Low Testosterone

Low testosterone (“low T”) is a controversial diagnosis. If you get such a diagnosis and your doctor advises you to take any of these medicines, get a second opinion.

A small percentage of men (usually in their 50s, 60s and 70s) have “low T,” but the manufacturers of these products have sought to create a condition that is not firmly established in medical literature — one marked by low energy and low sex drive due to “low testosterone.”

Don’t buy into it. The drugs can cause blood clots in the legs, sleep apnea, an enlarged prostate and possibly an increased risk of heart attack or stroke.

Instead, talk to your doctor about treating common underlying conditions that can decrease testosterone level, such as diabetes, obesity and aging. Also discuss non-drug ways to boost energy and vitality by exercising, getting enough sleep and couples therapy with your partner.

Actonel, Boniva and Fosamax to Treat Osteopenia (Low Bone Density)

These drugs, called bisphosphonates, are widely prescribed to treat a condition dubbed “pre-osteoporosis.” But there’s scientific controversy about the prevalence and impact of mildly or marginally low bone density, and whether it warrants treatment with these strong medicines.

All have side effects and carry risks, which include diarrhea, nausea, vomiting, heartburn, esophageal irritation and bone, joint or muscle pain. Long-term use has also been linked to an increased risk of fractures of the femur (thigh bone).

Before considering one of these medicines, walk more, quit smoking and try eating more foods high in calcium and vitamin D. If bone density tests show you have full-blown osteoporosis, you should consider one of these medicines. But use caution with long-term use.

Detrol and Oxytrol for “Overactive Bladder”

The sudden or frequent need to pee is frustrating and inconvenient. These medicines, called anticholinergics, are often prescribed even to people who have mild symptoms.

The drugs can cause constipation, blurred vision, dizziness and confusion. So before trying one, cut back on caffeine, soft drinks and alcohol, and watch your liquid intake overall. Also, try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises — repeatedly tightening and relaxing the muscles that stop urine flow. These techniques have been proven effective.

If several weeks or months of non-drug strategies don’t provide enough relief, consider an anticholinergic.

Actos and Glucophage for “Pre-diabetes”

Pre-diabetes is a widely accepted condition (unlike “low T”), but there’s no consensus on how aggressively to treat it, or if people with it should take drugs. People with pre-diabetes have blood glucose (sugar) levels at the high end of normal.

Because these diabetes medicines have side effects and carry risks — including dizziness, fatigue, muscle pain and, in rare cases, the dangerous buildup of lactic acid and a vitamin B12 deficiency — talk to your doctor about non-drug options first, such as exercise, a diet rich in unprocessed and non-starchy foods, and weight loss.

If you develop type 2 diabetes, however, you should consider a diabetes drug.

Drugs to treat Pre-hypertension

Like pre-diabetes, pre-hypertension is an accepted condition that warrants monitoring. It’s defined as blood pressure at the high end of normal. But, also like pre-diabetes, there’s no consensus on when to treat it with drugs.

Many classes of medicines are used. They include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers and diuretics. All are effective at lowering blood pressure but have side effects. Diuretics can cause frequent urination, low potassium levels and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums and, less often, breathing problems.

Unless a patient has other conditions that make the case for starting a drug, non-drug options are a better initial treatment to bring blood pressure into the normal range. Most important among them: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

Belviq, Contrave, Qsymia and Xenical for Obesity

These weight loss drgs have mixed effectiveness. They work for some people and not at all for others. For patients who are significantly overweight or have diabetes or heart disease, and have been unable to lose weight through exercise and diet, one of these medicines may be worth trying.

But the drugs should not be a first-line treatment for anyone who is just 10 to 20 pounds overweight and hasn’t yet really tried lifestyle and diet changes. All have side effects that are common and can be quite discomforting. Constipation, diarrhea, nausea and vomiting are common.

The drugs also carry rare but dangerous risks, including leaky heart valves with Belviq and liver damage with Xenical.

Americans are all too often pushed — or rushed — into taking drugs too soon. Sure, lifestyle changes can be hard. But they don’t have side effects and the risks are well defined and easily avoidable. And the payoff from adopting a much healthier diet or sticking to an exercise regimen often goes well beyond addressing the medical condition at hand and improves your overall physical and mental health.

Quick Hits: Antidepressant Use Soars, FDA Looks at Presenting Fewer Risks in Drug Ads and Marijuana Linked to Hypertension

Between 1999 and 2014, antidepressant use by Americans increased by 65%. By 2014, 1 in 8 Americans (12.7%) 12 and over reported using an antidepressant recently. In 1999, only 7.7% did, according to a new report published by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). Results also showed that women are twice as likely to take an antidepressant than men. Between 2011 and 2014, 24.4% of women had taken an antidepressant in the last month compared to 12.6% of men. Whites were more likely to use antidepressants than any other racial or ethnic group, with 16.5% of them admitting to doing so in the last month. That compares to 5.6% of blacks, 5% of Hispanics and 3.3% of Asians. Researchers also found that most people are using antidepressants over a long period of time. For example, 25% of people surveyed reported taking an antidepressant for 10 years or more, and 68% were taking one for 2 years or more. The findings are based on responses from a national health survey of more than 14,000 people conducted between 2011 and 2014, which were compared to responses from the same survey done in 1999. Posted August 16, 2017. Via NCHS.

The long list of risks mentioned in TV prescription drug ads may be whittled down to only covering the most severe risks and side effects. The FDA says research it has conducted found that “a more targeted presentation of risks” presented in direct-to-consumer (DTC) ads can lead consumers to remember more of the most relevant risks and side effects rather than overwhelming them with every single one. The agency noted that it wants to ensure consumers who are viewing these ads are walking away “properly informed” of the key benefits and risks associated with an advertised medication. The FDA is exploring the possibility that DTC ads will include only the most severe (life-threatening) side effects, along with a note that there are other risks not included in the advertisement. The FDA is also asking for comments from the public. “To inform our policies on how risks should be disclosed, we’re asking consumers, providers and other members of the public to help us better understand what risk information is most useful in TV and other broadcast ads,” FDA Commissioner Scott Gottlieb said in a statement. Posted August 18, 2017. Via FDA.

Regular marijuana use may more than triple the risk of dying from hypertension (high blood pressure). In addition, the risk increases with each year of smoking cannabis. Researchers from Georgia State University analyzed data from 1,213 people aged 20 and older who had been involved in an ongoing National Health and Nutrition Examination Survey. The information collected on marijuana use among the group was merged with mortality data from the U.S. National Center for Health Statistics in 2011. Researchers found that marijuana users had a 3.4 times higher risk of death from hypertension than non-users. Posted August 8, 2017. Via European Journal of Preventive Cardiology.

Quick Hits: New Med Doesn’t Help Lower Back Pain, Acupuncture & Electrotherapy Help After Knee Replacement Surgery, More

A medication for lower back pain could be ineffective and cause side effects.
A new study found that gabapentinoids –- an analgesic typically prescribed for lower back pain — may actually be ineffective and could cause unwanted side effects. A research team from Canada examined data from eight randomized trials that investigated the use of gabapentinoids in patients with chronic lower back pain. The study, which is published in the journal PLOS, found that gabapentin showed no significant improvement of pain in 3 out of the 8 trials. Additionally, researchers found that it could cause some side effects, including dizziness, fatigue and confusion. Posted August 16, 2017. Via Express.

Acupuncture, Electrotherapy after Knee Replacement Can Reduce or Delay Opioid Use. A new study published by JAMA Surgery found that acupuncture and electrotherapy could potentially reduce, or at least delay, opioid use after knee replacement surgery. A research team from Stanford University evaluated the effectiveness of commonly used drug-free alternative treatments for post-surgical pain post by examining data from 39 clinical trials, which consisted of 2,391 patients who had total knee replacements. Alternative treatments included continuous passive motion (CPM), preoperative exercise, cryotherapy, electrotherapy, and acupuncture. According to the results, electrotherapy and acupuncture “moderately” improved postoperative pain management and reduced opioid use. Cryotherapy reduced opioid use, but failed to alleviate pain. CPM and preoperative exercise did not reduce pain or reduce opioid use. Posted August 16, 2017. Via Medical Xpress.

Antidepressant use has risen significantly. According to new data from the National Center for Health Statistics (NCHS), the rate of antidepressant use has increased by 65% over the past 15 years. Antidepressant use increased with age in both men and women, from 3.4% among people aged 12 to 19 years to 19.1% among those aged 60 years and older. Additionally, women were found to be using antidepressants far more often than men. From 2011 to 2014, women were about twice as likely as men to report past-month antidepressant medication use (16.5% vs 8.6%). Posted August 15, 2017. Via Medscape.

Quick Hits: Some Drs Swapping Anti-Seizure Drugs for Opioids, a Corticosteroid Study Stopped & More

In an effort to combat the opioid epidemic, doctors may be overprescribing anti-seizure drugs as an alternative, according to a letter from researchers published in of the New England Journal of Medicine. Physicians are frequently prescribing the epilepsy drugs Neurontin (gabapentin) and Lyrica (pregabalin) to treat chronic pain.

However, these medications are only FDA-approved to treat certain types of pain, and may cause serious side effects if prescribed for the wrong type of pain symptoms. Some of the side effects patients have experienced include allergic reaction, fatigue, balance problems, impotence, change in bowel movements, sluggishness, confusion and dizziness. Researchers have suggested that doctors direct patients toward non-drug methods of pain management instead, such as physical therapy and cognitive behavioral therapy. Posted August 2, 2017. Via US News.

Researchers concluded a clinical trial early when they found that patients who were using a corticosteroid called methylprednisolone experienced severe side effects, including such serious infections as pneumonia and meningitis. The research team randomly administered either methylprednisolone pills or an inactive placebo to 262 patients with a kidney disease that causes inflammation (immunoglobulin A [IgA] nephropathy). The study’s results, which are published in the Journal of the American Medical Association, showed that nearly 15% of patients experienced a serious “adverse event” –- mainly infections –- over a 2-year period. Posted August 1, 2017. Via Health Day.

Pregnant women who take opioid painkillers together with psychiatric drugs for depression or anxiety during pregnancy have a greater risk of giving birth to an infant in withdrawal, according to a Harvard Medical School study. The study found that the risk and severity of drug withdrawal symptoms in newborns significantly increased when opioids were taken with psychiatric drugs, particularly antidepressants, benzodiazepines such as Valium (diazepam) and the seizure drug Neurontin (gabapentin). After examining more than 200,000 pregnant women, researchers found that mothers who took narcotic painkillers — such as OxyContin or morphine — with psychiatric drugs have a 30% to 60% greater risk of giving birth to an infant in withdrawal than those taking opioids alone. The highest risk of withdrawal — more than 11% — occurred with a mother’s use of gabapentin along with a narcotic painkiller. Posted August 2, 2017. Via Health Day.

Quick Hits: New Breast Cancer Drugs Have Fewer Side Effects, Antidepressant Use in Pregnancy and Autism & More

A new class of oral drugs for treating the most common type of breast cancer, known as cyclin-dependent kinase (CDK) inhibitors, appears to have fewer adverse events and side effects for most patients compared to other treatments. There are 2 CDK inhibitors currently on the market: Ibrance (palbociclib), approved in February 2015, and Kisqali (ribociclib), which was just approved in March. Both are used to treat hormone receptor-positive (HR+) metastatic breast cancer. A third CDK inhibitor, abemaciclib, is in late-stage development. Researchers examined all publicly available trials for the 3 drugs. The most common side effect was low white blood cells, a condition known as neutropenia that can lead to infection, though it was seen less in abemaciclib. However, neutropenia was usually temporary or resolved with a dose reduction. Other, more common side effects seen with the medications were diarrhea and fatigue. Less common side effects observed were nausea and alopecia (hair loss), though these were mild and treated through a dose reduction or a break from the drug. Posted July 14, 2017. Via The Oncologist.

Children exposed to antidepressants during pregnancy may have a slightly higher risk of developing autism than children of mothers with mental illness who didn’t receive the drugs. Researchers, however, stress that the absolute risk of autism was small, so the results should not be considered alarming. A team at the University of Bristol (UK) analyzed data from 254,610 individuals aged 4-17 of which 5,378 had autism. Of the 3,342 children exposed to antidepressants during pregnancy, 4.1% (136) had a diagnosis of autism compared with 2.9% (353) in 12,325 children not exposed to antidepressants whose mothers had a history of a psychiatric disorder. Researchers noted that overall, 95% of women who took antidepressants did not have a child with autism. An accompanying editorial noted that the results should not dissuade women with depression from using antidepressants in pregnancy since untreated depression can lead to “ substantial health consequences.” Posted July 19, 2017. Via The BMJ.

The FDA has approved a new hepatitis C (HCV) medication, Vosevi. The drug is actually a combination of two existing anti-viral treatments, sofosbuvir and velpatasvir (sold as Epclusa), and a new drug, voxilaprevir. Vosevi is for patients with HCV without liver disease (cirrhosis) or with a mild form of cirrhosis. Results from 2 late-stage trials demonstrated that 96-97% of patients who received Vosevi had no HCV detected in their blood 12 weeks after finishing treatment, an indication the infection has been cured. The most common side effects in patients taking Vosevi were headache, fatigue, diarrhea and nausea. Posted July 18, 2017. Via FDA.