Pharmacy & Therapeutics - January 2009 - (Page 19) NEW DRUGS continued from page 16 DRUG NEWS ures of cytogenetic damage in the white blood cells of each child in the study, such as chromosome breaks, and found no changes after three months of continuous treatment. The study was funded through the Best Pharmaceuticals for Children Act. The study included 63 children from 6 to 12 years of age who had not previously used stimulants. The children were divided into two groups and were treated either with methylphenidate HCl (Ritalin LA, Novartis; Concerta, McNeil) or with mixed amphetamine salts (Adderall and Adderall XR, Shire). The researchers found no significant differences between the two groups in age, sex, race, body weight, height, or ADHD subtype. A previous paper had reported that methylphenidate induced chromosomal changes in children with ADHD, but the current study was not able to replicate those findings. The researchers emphasize that these results should not be interpreted as final proof of the long-term safety of stimulant drugs. Sources: J Am Acad Child Adolesc Psychiatry, November 2008, online; www. nih.gov for bleeding, 3,277 (68%) received red blood cell transfusions, and 4,387 (92%) had the composite outcome. After an adjustment, early clopidogrel use was not significantly associated with re operation or with the composite endpoint. It was modestly associated with red blood cell transfusion, but more weakly than other factors, including which surgeon performed the procedure. The upshot: the impact of withholding clopidogrel in patients with ACS and the impact of delaying CABG (especially by more than two days) to prevent bleeding complications should be viewed in the context of other, stronger determinants of bleeding. Source: Am Heart J 2008;156:886–892 blocker doses in the first 60 to 90 days after discharge. At follow-up, only 18% taking carvedilol and 8% taking metoprolol succinate were receiving the recommended doses. Source: Am J Cardiol 2008;102:1524– 1529 New Guidelines For Congenital Heart Disease Many children born with congenital heart disease can live well into adulthood, thanks to new surgical and medical treatments. To assist cardiologists in making clinical decisions for this challenging group of patients, the American College of Cardiology and the American Heart Association have released practice guidelines. Some of the guidelines address coordinating patient care, counseling, helping patients switch from a pediatric to an adult cardiologist, and educating patients about the risks of infection to the heart lining or heart valves posed by dental procedures, tattoos, piercings, or surgery. The guidelines were developed by the American Society of Echocardiography, the Canadian Cardiovascular Society, the Heart Rhythm Society, the International Society for Adult Congenital Cardiac Disease, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. Sources: J Am Coll Cardiol 2008;52: e1–e121; Circulation 2008;118:e714– e833. Missing the Target With Beta Blockers Although national guidelines recommend that physicians make every effort to achieve the target doses of the beta blockers that are considered effective in major clinical trials, real-world evidence from a study of patients with heart failure (HF) reveals a substantial “titration gap.” The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZEHF) enrolled 5,791 patients at 91 academic and community hospitals across the U.S. Of 2,373 patients with systolic HF eligible for beta blockers at discharge, 1,350 (57%) who were receiving beta blockers continued with that treatment, and 632 (27%) were newly started. Of the 1,537 patients who were using beta blockers before admission, 1,350 (88%) continued therapy. The mean total daily dose before admission was less than half the recommended target dose, with infrequent uptitration or down-titration during the hospitalization. More than two-thirds of patients had no change in their beta Adenosine: Best Choice for Supraventricular Tachycardia? For some patients, adenosine may be the optimal drug for treating paroxysmal supraventricular tachycardias, say researchers in Italy. A retrospective study of 454 patients found that 331 (73%) responded immediately to the 6-mg dose, 68 (15%) responded after the second 12-mg dose, and five patients (1%) responded to another 12-mg dose. The remaining 50 patients (11%) were unresponsive. Adenosine has a half-life of less than one minute, and the time needed to reverse tachycardia ranges from seconds to a few minutes after the bolus is given. Adverse events are generally short-lived, ADHD Drugs Not Linked To Genetic Damage in Children In contrast to recent findings, two common medications used to treat attentiondeficit/hyperactivity disorder (ADHD) do not appear to cause genetic damage in children who take them as prescribed. Researchers at the National Institutes of Health (NIH) and Duke University Medical Center evaluated three meas- Vol. 34 No. 1 • January 2009 • P&T® 19 http://www.nih.gov http://www.nih.gov
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