Drug Topics - April 14, 2008 - (Page 30)

30 DRUG TOPICS APRIL 14, 2008 www.drugtopics.com Cover Story hyperactivity disorder (ADHD). investigate the effect of ADHD medications on risk of “ADHD is the most commonly diagnosed condition heart attack, stroke, and other cardiovascular problems which results in treatment in our practice,” said Joanne by analyzing the cardiovascular risks of 500,000 chilCiardullo, M.D., a pediatrician in private practice in dren and adults who took ADHD medications between Hershey, Pa., “but there is a stigma associated with 1999 and 2005. Results from the cardiovascular analythe diagnosis and certain sis are anticipated in August 2009. ADHD medications like In the meantime, since February 2007, the FDA DT CAPSULE Ritalin.” Ciardullo ex- has required that medication guides (MedGuides) be plained that parents rou- dispensed with ADHD prescriptions, to highlight the tinely express concern over potential side effects and serious risks that could be asthe effects of ADHD med- sociated with these therapies. ications on their child’s ADHD medications are not the only drugs that sleep and are anxious about come with increased pediatric warnings. It has been whether the drugs will be four years since the FDA first initiated a health advisory able to be discontinued at warning regarding the increased risk of suicide with some time in the future. antidepressant use in children and adolescents. Does Concern over use of stimulants often prompts par- this risk educate parents, or serve as a barrier in getting ents to inquire about the non-stimulant ADHD option, treatment to patients who truly need it? According to atomoxetine (Strattera, Lilly). But how effective is it? Ciardullo, the parental reaction to the suicide warning Prime Therapeutics, a pharmacy benefits manager in to antidepressants is quite different than that to the the Midwest, found that although one out of every psychiatric risks associated with ADHD medications. five ADHD patients started therapy with atomoxetine, “Parents are considerably more open to the treatment children who initiated therapy with atomoxetine were of depression compared to ADHD,” she said. “This is 4.2 times more likely to switch or add on therapies than likely due to the fact that many parents do not consider those who started with stimulants. Patrick Gleason, ADHD to be as serious as depression. Parents associate Pharm.D., director of outcomes assessment at Prime ADHD with outcomes such as performance in school. Therapeutics, said the reason is “likely a combination They don’t believe the outcomes can be as negative as of safety, efficacy, and cost.” Gleason continued, “Due with depression.” to the short time atomoxetine has been Since the FDA’s health advisory available, little is known about the long- DT CAPSULE warning in 2003, numerous studies term exposure risk.” This raises many have attempted to track prescribing questions regarding which regimen is practices of antidepressants in pediatric appropriate for initiation of therapy. The and adolescent populations. The inforMedical Letter, which published ADHD mation, however, appears contradictory, treatment guidelines in 2006, claims with one widely publicized study re“atomoxetine is less effective than the porting an increased use of antidepresstimulants in reducing the symptoms of sants, particularly among teenage girls ADHD,” and recommends commencbetween 2002 and 2005, but another ing therapy with either an oral amstudy found a decreased use. phetamine or methylphenidate. HowThe FDA has extended the black box ever, said Ciardullo, “Methylphenidate warning for suicidal ideation to include is particularly unpopular among parents, young adults up to the age of 25; the possibly because it is an older drug that previous black box warning had only has historically received negative media applied to children and adolescents. attention.” The FDA’s decision was not well received by psychiaRecent attention has focused on the risks of cardio- trists and mental health advocacy groups, which have vascular adverse effects and psychiatric conditions as- publicly criticized the move. Those opposed to the sociated with ADHD medications. The cardiovascular FDA’s decision claim that extending the warning will risk of ADHD medications was brought to light as have a negative effect on prescribing antidepressants a result of 27 sudden, unexplained deaths in patients in young adult patients. Ultimately, only time will tell younger than 18 using these drugs between 1992 and if the labeling change will be associated with positive 2005. The Agency for Healthcare Research and Qual- or negative outcomes. Perhaps as a recent Archives of ity (AHRQ) is currently collaborating with the FDA to General Psychiatry report finds, treatment of depression Childhood obesity causes hypertension to become apparent at an earlier age. Diovan and Cozaar are approved for treating hypertension in children as young as six. http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics - April 14, 2008

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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