Pharmacy & Therapeutics - February 2009 - (Page 69)

NEW DRUGS sedation, chest infections, a decline in brain function, stroke, and death. Antipsychotic agents are not indicated for treating dementia, but many elderly people in nursing homes have received them, often with little evidence to support such use. Researchers at King’s College in London randomly assigned 128 patients with AD to receive a placebo or an antipsychotic agent such as thioridazine (Mellaril, Novar tis), chlorpromazine (Thorazine, GlaxoSmithKline), haloperidol (Haldol, Or tho-McNeil), trifluo perazine (Stelazine, GlaxoSmithKline), or risperidone (Risperdal, Janssen). For the study period, the risk of death was 42% lower with a placebo than with an antipsychotic drug. After one year, 70% of the patients taking antipsychotic drugs were still living, compared with 77% of the placebo patients. After two years, 46% of those taking the medications were alive, compared with 71% of those taking placebo. After three years, only 30% of those using antipsychotic agents were alive, compared with 59% of the placebo group. Antipsychotic medications can be beneficial in dementia if patients are becoming aggressive and if other measures have failed. These drugs should be used for the shortest possible time at the lowest possible dose. Adjusting the patient’s environment, changing the way patients are addressed, and eliminating events that may trigger deteriorations in patient behavior should be tried first. Sources: Lancet Neurol, Januar y 8, 2009, online; Washington Post/Healthday News, January 9, 2009 DRUG NEWS cedure that restores blood flow to the hear t muscle with a balloon-tipped catheter or with bypass surgery. New criteria focus on treatment rather than on diagnostic testing. The guidelines address (1) the severity and type of symptoms (2) how much cholesterol plaque has built up, (3) how much of the hear t muscle, after stress testing, is starved for blood and oxygen, and (4) whether the patient is already taking the right medications in the right dosages. Revascularization is considered inappropriate for patients with plaque buildup in one or two arteries or who have symptoms only during heavy exercise, and a small risk of heart muscle problems; it might also be ruled out if the patient is not taking drugs to control symptoms. However, the procedure would be appropriate if a similar patient had severe symptoms even after taking the most effective, available heart medication. The guidelines will be used to evaluate patterns of patient care and to reduce the large variations in rates of revascularization in parts of the U.S. It is hoped that health insurers will use these criteria to develop consistent payment policies and conduct quality reviews. Sources: Catheter Cardiovasc Intervent and Circulation, January 5, 2009; J Am Coll Cardiol, February 10, 2009. (second-generation) agents such as risperidone, quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril) had a higher risk of sudden death from cardiac causes than patients who did not take these drugs. For both drug classes, mortality risk increased with higher doses. Even though atypical antipsychotic agents are often used to treat schizophrenia and bipolar disorders, they are also prescribed “off-label” for agitation, anxiety, psychotic episodes, and obsessive behaviors. The newer-generation agents are less likely to cause tremors, associated with the older drugs. Researchers at Vanderbilt University and Nashville Veterans Affairs Medical Center evaluated 93,300 users of single typical and atypical drugs, matched with nonusers of antipsychotic drugs. The current users of antipsychotic drugs had roughly twice the rates of sudden cardiac death than did nonusers. During a million-plus person-years of follow-up, 1,870 patients died, or 18 per 10,000 person-years. The unadjusted rate increased from 4.7 deaths per 10,000 for those aged 30 to 34 at baseline to 47.6 per 10,000 for those 70 to 74 years of age. The mortality rate was more than twice as high for men as for women. Current users of high-dose thioridazine had the highest risk. These findings may help clinicians weigh the risks and benefits of these drugs before prescribing them for offlabel uses. Sources: N Engl J Med, 2009;360:225– 235; Agency for Healthcare Research and Quality Health Insurance Bill Passes The House of Representatives has approved an expansion of the government’s health coverage for children from low-income families. The measure was expected to move quickly through the Democratic Congress. As President-elect, Barack Obama had hailed the 289–139 vote and urged the Senate to act rapidly. During his candidacy, he had vowed to provide health coverage to all children. The expansion of the State Children’s Health Insurance Sudden Cardiac Death in Adults When it comes to the risk of sudden cardiac death, the newer, atypical antipsychotic drugs may be no safer than the older drugs. Patients 30 to 74 years of age who took atypical antipsychotic New Guidelines For Treating Heart Blockage How should doctors treat clogged arteries in the heart? Sometimes chest pain can be treated with drugs alone or with drugs plus revascularization, a pro- Vol. 34 No. 2 • February 2009 • P&T® 69

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Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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