Drug Topics - April 14, 2008 - (Page 32)

32 DRUG TOPICS APRIL 14, 2008 www.drugtopics.com Cover Story in young people is best handled not with medication alone. Instead, medication should be combined with cognitive behavioral therapy (CBT), a form of psychotherapy which helps patients manage their thoughts and feelings. DT CAPSULE Even more controversial than ADHD medications and antidepressants is the diagnosis and treatment of bipolarism in children. Since 1996 when Biederman and colleagues reported in the Journal of the American Academy of Child & Adolescent Psychiatry that 23% of the ADHD population also meets criteria for bipolar disorder, the diagnosis of this psychiatric condition in children has risen by a dramatic 4,000%, and coinciding with the diagnosis has been an increase in childhood use of antipsychotic medications. Some experts express concern about the safety of potent antipsychotic medications in youngsters whose bodies and brains are still growing, especially since the FDA’s recent decision to approve risperidone for bipolar patients age 10-17 was based on short-term studies that included fewer than 200 young people. Similarly, Otsuka Pharmaceuticals just announced that aripiprazole (Abilify), too, has received approval for treating bipolar disorder in 10- to 17-year-olds after only one four-week trial involving 296 youngsters. In addition to weight gain, a different side effect—hyperprolactinemia—was detected in more than 50% of pediatric patients with risperidone. Otsuka’s press release announcing the new indication warned that “children and adolescents might be more sensitive than adults in developing antipsychotic-related adverse events.” Only Xenical is approved to treat obesity in adolescents and teens. What can pharmacists do? First, it is important for pharmacists to understand with respect to black box warnings that these label changes are not synonymous with contraindications; the purpose of the box is to highlight serious known risk, like antidepressants and suicidal thoughts, and even unproven risks, such as possible cardiac events. Second, when dispensing these and other “black box drugs,” pharmacists need to take special care to counsel patients, encouraging them to follow appropriate monitoring recommendations. Third, pharmacists must dispense the required MedGuides for all new and refilled “MedGuide drug” prescriptions. Finally, when dispensing antipsychotic medications to young people, counseling about good nutrition and exercise as well as regular weight/blood sugar monitoring is imperative to warn parents and young people of the risks known to be associated with use of these medications. In sum As nice as it would be, children do not come with an instruction manual and they pose many challenges. Perhaps nowhere is that more apparent than in the lack of information available for medicating children appropriately. The need for pediatric-based clinical trials is clear. Until those studies are conducted, pharmacists should identify the evidence-based options available and try their best to educate parents and young people about the appropriate use of medications.   , Ph.D., R.Ph., is assistant professor Department of Pharmacology, at Penn State University College of Medicine. Megan Barnes is obtaining her Pharm.D. degree from Duquesne University. Avani Patel is completing his Pharm.D. degree at University of Pittsburgh. How should kids with cough and cold be treated now that FDA has recently withdrawn over-the-counter products for infants with this condition? Please go to www.drugtopics.com and look under Web Exclusives. http://www.drugtopics.com http://www.reesepharmaceutical.com http://www.reesepharmaceutical.com 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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