Pharmacy & Therapeutics - February 2008 - (Page 89)

NEW DRUGS variation in risk. The team analyzed data from more than 2,000 women enrolled in WECARE, a study involving 1,394 women with breast cancer and an additional 704 women with contralateral breast cancer (separate cancer in both breasts). The women were younger than age 55 at diagnosis, and cancer had not spread beyond the regional lymph nodes. The study focused on the incidence of breast cancer in the first-degree relatives of the 181 women with a mutation in BRCA1 or BRCA2. Relatives of the women with a breast cancer diagnosis at age 35 or younger had a higher incidence of breast cancer than relatives of women with a diagnosis between 45 and 54 years of age. The risk also varied among families and according to lifestyle and environment. The risks were generally higher in families with multiple cases of breast cancer, but the likelihood of breast cancer developing in a healthy woman without a family history after testing positive for a BRCA1 or BRCA2 mutation tended to be lower than current estimates of lifetime risk in carriers. Women carrying mutations in one of two genes face a 40% to 51% risk of developing breast cancer by age 70; this rate is lower than the commonly cited risk of 50% to 80%. About 0.5% of women in the U.S. carry these genes, which are also linked to ovarian cancer risk. Women were at a higher risk if a relative’s breast cancer was diagnosed at a young age or if it had occurred in both breasts. Genetic testing is recommended only for women with families already affected by cancer. (Sources: JAMA and The Wall Street Journal, January 9, 2008.) DRUG NEWS withdrawal; three as a recreational drug, and four for unknown reasons. The researchers compared those patients with 106 patients with sudden cardiac death who had no evidence of methadone use, recreational drug use, or a drug overdose. Among the patients using methadone, five (23%) had a cardiac abnormality that might have caused sudden cardiac death; all of these had significant coronary artery disease. With the other 17 patients, no significant cardiac abnormality was found. By contrast, 60% of patients who were not using methadone had cardiac abnormalities, most of them significant. There have been concerns about two potentially lethal adverse ef fects of methadone: acquired prolonged QT syndrome, which can increase the risk of torsades de pointes, and respiratory de- situations, for example, in opioid withdrawal, as a long-acting analgesic for neuropathic pain syndromes, and as a low-cost alternative to more expensive opiates. However, therapeutic-use methadone has been linked with sudden cardiac death. Researchers from Oregon Health and Science University in Portland performed a four-year communitybased study to evaluate the association. They identified 72 patients with sudden cardiac death and evidence of methadone at a toxicologic screening. Of those patients, 43 who had died of a methadone overdose, recreational druguse, or an overdose were excluded from the case group. Of the remaining 29 patients, only 22 underwent a detailed autopsy. All of the patients had therapeutic levels of methadone: 12 had been using it for pain control, three for opioid Master’s Degree in Public Health The Public Health Program at Thomas Jefferson University offers: • An easily accessible and safe location in center city Philadelphia • Conveniently scheduled classes • A program that you can complete at your own pace in 2 to 4 years • Meaningful research and clerkship programs with opportunities in the community and abroad For more information, please contact Jennifer Ravelli, MPH at 215-503-0174, by email at jennifer.ravelli@jefferson.edu Methadone And Sudden Cardiac Death Methadone has proved useful in many Visit our website at www.jefferson.edu/jcgs Vol. 33 No. 2 • February 2008 • P&T® 89 http://www.jefferson.edu/jcgs http://www.jefferson.edu/jcgs

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Pharmacy & Therapeutics - February 2008 Contents Editorial Medication Errors Prescription: Washington The Language of (Forgive Us) Change, As P&T Enters the Digital Age New Drugs/Drug News/New Medical Devices Drug Forecast Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience American Society of Hematology, 49th Annual Meeting Pharmaceutical Approval Update

Pharmacy & Therapeutics - February 2008

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