Wednesday, April 23rd, 2014
Doctors are continuing to prescribe codeine to children despite nearly two decades of warnings against its use, according to new research published in the journal Pediatrics. More from CNN:
Every year, there are up to 870,000 prescriptions of codeine written for children in emergency rooms in the United States.
And that’s a huge danger, because the narcotic can have particularly powerful effects on children. So powerful that the American Academy of Pediatrics issued guidelines against its use in 1997. Yet, despite those guidelines, a new study in the journal Pediatrics has found that little has changed in codeine prescribing habits.
Study author Dr. Sunitha Kaiser and her colleagues evaluated the National Hospital and Ambulatory Medical Care Survey database for emergency room visits of children between the ages of 3 and 17 from 2010 through 2010. They found found that in the nine years evaluated, the percentage of codeine prescriptions dropped very little – from 3.7% to 2.9%.
Codeine can be a particular threat to children, because they can metabolize it very differently than adults. Up to a third of all children don’t process it efficiently, so that they need more than a standard dose. Another 8% of children metabolize it too quickly, meaning a standard dose can result in a fatal overdose.
“Codeine is notorious for rashes, hives, vomiting in kids, and constipation. You can be allergic to it,” says Dr. Alan Woolf, director of the Pediatric Environmental Health Center at Boston Children’s Hospital. Woolf wrote an accompanying editorial titled “Why Can’t We Retire Codeine?” in the same issue of Pediatrics.
Kaiser and her colleagues found that children between the ages of 8 and 12 were most likely to be prescribed the drug. While coughs and colds were commonly cited as a reason for codeine, the AAP’s guidelines specifically state “no well-controlled scientific studies were found that support the efficacy and safety of narcotics (including codeine).”
“Codeine’s been around a long time. You know, just like many other drugs, there’s complacency about it. Because it has such name value, people assume it’s safe. … And I don’t think a lot of practitioners, and a lot of (the) public, makes the connection between codeine and narcotic,” says Woolf.
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Monday, April 14th, 2014
The antiviral medication Tamiflu may not be any more effective than other methods of treating influenza, or flu viruses, according to a new study published in the journal BMJ. More from Time.com:
There isn’t strong evidence to support stockpiling the products in national emergency drug depots in case of a pandemic, the researchers say. Both drugs—Tamiflu is the brand name for oseltamivir and Relenza is the brand name zanamivir—are designed to stop the influenza virus from spreading in an infected person, and claim to reduce the severity of flu symptoms and how long people are sick. The Centers for Disease Control and Prevention keeps the drugs in its stockpile for use in both seasonal and pandemic flu situations, and the European Medicines Agency (EMA) and the World Health Organization also recommend the medications for treating flu.
The authors of the current review found, however, that in the case of the European approvals in particular, regulatory agencies relied on summaries of studies rather than an exhaustive analysis of raw data, known as clinical study reports, which can run to more than 1,000 pages and detail methods, protocols and statistical analyses.
After a four-year effort to obtain this data from both the manufacturers and the EMA, the authors report in the journal BMJ that those trials do not support claims that the drugs lower the risk of complications from flu, such as pneumonia, or that the benefits of the drugs outweigh their risks, which include nausea, vomiting, headaches and kidney disorders.
The authors point to not just one failure in the process of approving these medications, but a weak regulatory system in which the studies are all conducted by manufacturers, and in which the trials compared the medications against placebo rather than to existing flu treatments.
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Friday, February 28th, 2014
Low birth weight babies, whose organs are often underdeveloped, may face lifelong difficulties in metabolizing medications, which can complicate the treatment of illnesses they might encounter in the future. A new study from researchers at Oregon Health & Science University and Oregon State University is the first to implicate low birth weight as a permanent factor in drug response.
When more fully understood, low birth weight may be added to the list of factors already being considered in medication dosages, such as age, weight, gender and ethnicity. Some of that is already being done in infants. But right now it’s not one of the factors considered in adults, scientists say, and more work needs to be done before such consideration is warranted.
“Low birth weight affects the development of organs, as the fetus tries to finish development of the brain and, in a sense, sacrifice as necessary the ordinary development of organs such as the kidney,” said Ganesh Cherala, an assistant professor in the OSU/OHSU College of Pharmacy, in a statement. “But the kidney is one of the primary filtering agents in the body, and is directly involved in drug elimination.”
The kidneys of low birth weight individuals have a significantly impaired ability to filter and excrete foreign compounds, Cherala said. Since the biologic impact of a medication is affected by its absorption, metabolism and excretion, low birth weight individuals might be less able to excrete drugs.
However, the biologic processes are not that simple, Cherala said. Because of liver metabolism and other issues, in many cases low birth weight individuals end up having less response to a drug, instead of more.
“A pain killer, for instance, might end up being metabolized in the liver instead of making its way to the brain where it is supposed to function,” Cherala said. “You might need more of that same drug in a low birth weight individual to have the same effect.”
The complexities of these processes need additional study before recommendations could be made to alter drug dosages based on low birth weight status, Cherala said. But this issue could be important and should be further explored, he said.
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Monday, January 13th, 2014
Mothers who regularly use over-the-counter pain medications like ibuprofen and acetaminophen are more likely to medicate their children more often, using similar medications, according to a new study conducted by Danish researchers. More from Reuters:
More parents are giving OTC medications, such as acetaminophen, to their young children, often without the advice of health care professionals, the study team says.
“Half of all the medications used worldwide are non-prescription – it is a huge and growing industry under limited control from the health care system,” Dr. Janne Fangel Jensen, who led the research, told Reuters Health by email.
Jensen is a researcher with the Department of Public Health at the Faculty of Health and Medical Sciences, University of Copenhagen, in Denmark.
Acetaminophen – sold as paracetamol outside of the U.S. – is the most widely used drug in many developed countries. It’s a safe treatment for many forms of mild pain and has few known side effects, Jensen said.
But overdosing with acetaminophen can be dangerous, she cautioned. “In my opinion it is important to limit the use of paracetamol to when it is indicated and to prevent an increasing ‘over-medication’ especially in children.”
To gauge whether a mother’s use of painkillers influences how often children take the drugs, the researchers surveyed mothers of 131 Danish children ages 6 to 11.
Jensen and his colleagues asked how often the children were given non-prescription pain relievers during the previous three months and during the past year. They also asked how often the children had felt pain. In addition, there were questions about the mothers’ use of medication and general health.
The researchers found that 45 percent of the children had been given OTC pain relievers, mostly acetaminophen, during the previous three months. And 22 percent were given acetaminophen at least every other month for the previous year.
One-third of the mothers said they had chronic pain and 39 percent reported taking OTC pain relievers at least once per month, Jensen’s team reports in Pediatrics.
The researchers discovered that mothers who believed their children had recurrent pain tended to give them acetaminophen at least every other month.
And, in general, mothers who took pain relievers themselves every month also reported giving acetaminophen to their children more often during the previous three months.
“Our main finding is that mothers who use more OTC analgesics themselves have a tendency to also give it more often to their children,” Jensen said.
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Friday, January 10th, 2014
Tamiflu, a common medication used to treat seasonal flu, is in short supply in its oral suspension form, which is used to treat children suffering from the flu. The shortage is temporary, and it is due to an early demand for the drug in what is shaping up to be a powerful flu season, according to Roche Holding AG’s Genentech unit which manufactures the drug. Reuters has more:
“A brief shortage of OS is expected through mid-January. We may be unable to fill complete orders from distributors for a limited time,” [Roche spokeswoman Tara] Iannuccillo added.
Tamiflu is used to reduce the severity of the flu when taken at the outset of symptoms. The oral suspension of the drug is primarily prescribed for children under the age of 13 and for people who have difficulty swallowing.
The delay in packaging of the liquid version has not impacted supplies of regular Tamiflu 75 milligram capsules, Genentech said.
The flu is spreading quickly this season, with 25 states already reporting cases, according to the U.S. Centers for Disease Control and Prevention.
Thousands of people die every year from flu, which typically peaks in the United States between the months of October and March. This season’s virus has killed six children in the United States so far, according to CDC data.
Roche said it expects to have additional supply of Tamiflu OS available in mid-January.
“We expect that these new supplies should meet demand for OS overall and we will continue to receive and ship out new supplies of Tamiflu OS and capsules throughout the flu season,” Iannuccillo said.
If the drug is unavailable in a particular area during the shortage, pharmacists can mix the capsules into an oral suspension for people who need it.
Meanwhile, the CDC is recommending that people continue to get flu shots to prevent the virus.
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