Drug Topics - April 14, 2008 - (Page 28)

28 DRUG TOPICS APRIL 14, 2008 www.drugtopics.com Cover Story cardiovascular disease, children are not usually the patients that come to mind. However, the incidence of these conditions is rising among young people, according to a recent report presented at the annual American Public Health Association meeting in Washington, D.C., which detailed a collaboration between Saint Louis University School of Medicine and School of Public Health as well as Express Scripts, the pharmacy benefits manager. Using claims and eliDT CAPSULE gibility information for more than 3.5 million children enrolled with Express Scripts, a substantial increase in the use of oral hypoglycemic agents was noted between 2002 and 2005. Specifically, among adolescent females, a 166% increase was observed, followed by a lower increase in use —39%—among adolescent males. According to Emily Cox, Ph.D., R.Ph., a senior research director at Express Scripts, “From our data, metformin accounts for 83% of all oral hypoglycemic drugs prescribed to adolescents.” Why the sharp increase in use of hypoglycemics among female youngsters? “Without further research, conclusions can’t be made about the unusual trend of such a large rate of increase in Type 2 diabetic medications in girls and not boys,” said Cox, but she speculated, “the magnitude of increase in female use over males may be due to differing rates of screening, office visits, and medication compliance.” Similarly, between 2002 and 2005, according to Cox, use of antihyperlipidemic medications also increased by 15% in pediatric populations, with the majority of the increase due to use of statins. Currently four statins, lovastatin, simvastatin, pravastatin, and atorvastatin, have FDA approval for use in children with familial hypercholesterolemia. Experience with these drugs in children is limited, and questions remain about when to treat. Some cardiologists take “the earlier, the better” approach, initiating treatment as early as eight years of age, while others take a “later, but greater” approach. The American Heart Association suggests that antihyperlipidemic therapy should not start before age 10 and preferably after the onset of menses in girls. Monitoring of height, weight, and sexual maturation is recommended-–the latter being particularly important since cholesterol is a biologic precursor to development of sex steroids. A small, 1.8%, increase in the use of antihypertensive agents has also been observed among adolescents. When treating hypertension in children, clinicians appear to be steering away from beta blockers and calcium channel blockers and, instead, leaning toward angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). “The changing trend in antihypertensive choice is likely due to physician preference,” suggested Ronald Williams, M.D., director of the pediatric multidisciplinary weight loss program at Penn State University College of Medicine, who indicated that although he has seen a small increase in antihypertensive use in children, he prefers to educate patients about lifestyle changes first. Several ACEIs have indications for use in children, but only valsartan (Diovan, Novartis) and losartan (Cozaar, Merck) are approved ARBs for use in treating pediatric hypertension in children ≥ 6 years of age. The big question surrounding use of oral hypoglycemic drugs, cholesterol medications, and antihypertensive agents is why has usage of these medications increased in children? Answers that have been suggested include genetic predisposition, side effects to other medications, and, of course, the obesity epidemic. “Even though some children are genetically predisposed to conditions such as essential hypertension, childhood obesity causes the condition to become apparent at a younger age,” said Williams. He added that risperidone (Risperdal, Janssen) and valproic acid (Depakote, Abbott) are associated with weight gain and are increasingly used in youngsters with mood disorders and psychological diagnoses. “Pharmacists should make an effort to inform parents about the risk of weight gain with these medications,” suggested Williams. Cox cautioned against pointing the finger only at obesity without considering other causes and noted, “While obesity certainly may be a contributing factor, obesity growth in young females does not parallel the increase in Type 2 diabetic medication use in girls over boys.” Several medications are used to treat obesity in More than two thirds of medications currently used in children have never been tested in clinical trials for safety and efficacy in pediatric populations. Jose Luis Pelaez Inc./Blend Images/Getty Images http://www.drugtopics.com

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Drug Topics - March 14, 2008 Contents Latebreakers Letters: Students Need Grounding in Chemistry Pharmacy Directors Wary of Heparin Shortages Some E-prescribing Standards are Ready to Go, Others are Not News Briefs Nanotechnology: Big Stakes in a Small World Pay for Performance is Coming to Pharmacy Patient Safety Organizations Still Very Much in Planning Stage Reconciling Medications in Specialty Patients Poses More Challenges Pharmacy Outsourcing Still Much in Use by Hospitals Studied Extensively, New Drug-Eluting Stent Said to be Very Safe Prevention is Key in Treating C. Difficile Infections E-prescribing Grows in Massachusetts, but Other States Lag Behind Active Metabolite Gives New Life to Antidepressant NSAIDS not Recommended for Long-term Use in Osteoarthritis This Time R.Ph.s and States Are Ready for Tamper-Resistant Rx Pads Cardinal Caught Between DEA and Pharmacies over Diversion Control Medicating Kids: Still More Questions than Answers Schnucks Pharmacy: Drug Topics' Chain of the Year Panel Will Ask for a System for R.Ph. Practice Across State Lines FDA Safety Page: How to use Fentora Safely The Shining OTC/HBC Stars of 2007 Take a Look at These OTCs for Eye Health Technology Update: Google Offers a Sneak Peak at its Electronic Records Initiative Recent Advancements in HIV/AIDS Treatment New Products Advertisers Index Classified Viewpoint: Are State Boards of Pharmacy Abusing Their Power?

Drug Topics - April 14, 2008

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