Excessive Heat Can Harm Medications, Expert Says

 

Don’t travel with meds in your car trunk or leave them in a parked car, she advises

 

From the 20 August 2011 Health Day news article

 

SATURDAY, Aug. 20 (HealthDay News) — Medications can be harmed by high temperatures, say pharmacists.

Although just a handful of drugs have been tested at temperatures above 86F, all medications could be altered by extreme heat, they warn.

According to Dr. Amy Peak, clinical pharmacist and director of Drug Information Services at Butler University, several medications have been tested at high temperatures. She outlined some of the changes the researchers found:

• Albuterol inhalers: The container could burst at temperatures above 120F. Moreover, when stored at high temperatures, there may be a decrease in the amount of medication inhaled.
• Concentrated epinephrine: Cyclical heating could reduce 64 percent of the medication’s potency.
• Diazepam: Concentration of this drug dropped 25 percent when stored at 98.6F.
• Formoterol (capsules that are placed in inhalers): Following four hours of exposure to 158F heat, the amount released from the capsules was less than half the normal amount.
• Lorazepam: When stored at 98F, concentration decreased 75 percent.
• Mometasone (formoterol inhalers): Temperatures above 120F may cause the container to burst.

Peak says several more medications may be susceptible to excessive heat, including:

• Insulin: Excessive heat could make the insulin less effective. It could also cause the insulin vials to explode.
• Thyroid hormones: Thyroid hormones could be altered by excessively high temperatures, resulting in inconsistent doses.
• Any medications in aerosolized canisters could burst when exposed to temperatures above 120F.

Although the United States Pharmacopeia Convention Inc. recommends that medications be protected from excessive heat, only a few drugs are actually tested at temperatures above 86F, Peak pointed out.

Nevertheless, she noted there are a number of steps people can take to ensure the quality of their medications during heat waves, including:

• Be aware that temperatures inside cars can top 160 F. When driving, be sure to keep medications out of the trunk and in the climate-controlled passenger compartment.
• Never leave medications in a parked car.
• During heat waves, have medications shipped overnight in special cooled containers.
• Request a one-time replacement from your insurance company or drug manufacturer for any medication that may have been affected by excessive heat.

SOURCE: Butler University, news release, August 2011

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Drug Shortages?

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From a 21 June 2011 Capital Area District Library Blog item

Maybe you’ve seen a little item in the news lately about shortages of important “medically necessary” medicines.  You probably dismissed it as something that doesn’t affect you, however, you might be interested to know that the shortages include cancer drugs, anesthetics used for patients having surgery, injectibles used in emergency treatment, electrolytes, and medicines that many Americans take daily for chronic conditions.  Curious now?

Fortunately, monitoring production supplies and shortages and working closely with U.S. drug makers is one of the important jobs of the U.S. Food and Drug Administration (FDA).  They report that “…the number of drug shortages has tripled over the last six years – jumping from 61 drug products in 2005 to 178 in 2010 – …”  So, as a consumer and patient what can you do?  First of all, be in touch with your medical care provider to assess your individual situation and needs.  Second, take a look at the list of Current Drug Shortages.  If you believe a drug you’re taking is in short supply and isn’t on the list, you can contact the FDA’s Center for Drug Evaluation and Research at drugshortages [at] fda.hhs.gov.

You can find this and other Consumer Updates atwww.fda.gov/ForConsumers/ConsumerUpdates.  Also, you can sign up for free email subscriptions to FDA news at  https://public.govdelivery.com/accounts/USFDA/subscriber/new?topic_id=USFDA_9

Eunice B., CADL Reference Librarian

 

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More Being Prescribed Psychiatric Medications With No Diagnosis

From the 4 August Medical News Today article

59.5% of antidepressant prescriptions were made with no diagnosis in 1996, in 2007 the figure rose to 72.7%, researchers reported in Health Affairs. Antidepressant drugs are today the third most commonly prescribed class of drugs in the USA.

Nearly 8.9% of the American population had at least one antidepressant prescription during any given month during the period 2005-2008.

A good proportion of this growth in antidepressant prescription has been by non-specialist providers whose patients were not diagnosed by a psychiatrist.

Read the entire article

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Environmental Pollutants Lurk Long After They ‘Disappear’

From a 20 July 2011 Science Daily article

The health implications of polluting the environment weigh increasingly on our public consciousness, and pharmaceutical wastes continue to be a main culprit. Now a Tel Aviv University researcher says that current testing for these dangerous contaminants isn’t going far enough.

Dr. Dror Avisar, head of the Hydro-Chemistry Laboratory at TAU’s Department of Geography and the Human Environment, says that, when our environment doesn’t test positive for the presence of a specific drug, we assume it’s not there. But through biological or chemical processes such as sun exposure or oxidization, drugs break down, or degrade, into different forms — and could still be lurking in our water or soil….

Read the article

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New Report Shows 85% of Fake Online Drug Outlets Don’t Require Valid Prescription, Fuel Prescription Drug Abuse

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From the 28 July 2011 Drug Information Forum article by Marvin C Pankaskie

The National Association of Boards of Pharmacy^® (NABP^®) today issued a public health alert to warn Americans about the serious dangers associated with medicines purchased through fake online pharmacies. A report NABP released today on Internet drug outlets found that 96% of 8,000 rogue Web sites analyzed continue to operate out of compliance with United States pharmacy laws, fuel prescription drug abuse and misuse, and provide an outlet for counterfeit medicines to enter the US drug supply – all of which significantly endanger the health and safety of Americans.

“The fake online pharmacy crisis has reached an epidemic level – they prey on prescription drug abusers and the most vulnerable members of society who rely on medicine every day for their health,” said NABP President Malcolm J. Broussard, RPh. “They offer easy access to potent medicines without a prescription and indiscriminately push dangerous counterfeit drugs. This problem poses a clear danger to Americans’ health and safety and weakens the essential relationships between pharmacists and patients. By issuing a public health alert, we are calling on pharmacists, physicians, and other health professionals to educate their patients about the growing public health threat posed by these illegal online enterprises.”

http://www.nabp.net/news/nabp-issues-rogue-online-pharmacy-public-health-alert/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NabpNewsroom+%28NABP+Newsroom%29

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Celebrity endorsements of prescription drugs

From the 7 July 2011 KevinMD column by Richard Meyer

Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products?  Well, according to an Ace Metrix study the answer to that is “probably no.”

The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case perform much worse.  In their study whether or not a celebrity endorses a product was unimportant in determining whether an ad resonated with viewers.  In fact compared with industry norms relatively few celebrity ads were able to earn performance marks above the industry averages…

Read entire article

Studies Evaluate Criteria For Detecting Potentially Inappropriate Medications In Older Hospitalized Patients

From the 13 June 2011 Medical News Today article

 Using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria was associated with identification of adverse drug events in older patients, according to a report in the June issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal’s Less Is More series.

According to information in the article, adverse drug events (ADEs) are a significant issue in the older population, and are thought to represent an important cause of hospitalization and account for substantial health care expenditures. Some ADEs are associated with potentially inappropriate medications (PIMs): agents that may cause problems in older patients “because of the higher risk of intolerance related to adverse pharmacodynamics or pharmacokinetics or drug-disease interactions.” During the last two decades, the Beers criteria for judging whether a medication is appropriate for use in an older patient have become the leading standard. Nevertheless, the authors write, research into whether the Beers criteria are associated with avoidable ADEs has not generated consistent results….

…According to the authors, the results suggest that STOPP criteria were more likely than Beers criteria to reveal ADEs in general, avoidable or potentially avoidable ADEs, and ADEs that may have factored into the patient’s hospitalization. “We believe that this finding strengthens the argument for the use of STOPP criteria in everyday clinical practice as a means of reducing the risk of ADEs in older patient,” they write. …

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Article Outlines Principles For A Conservative Approach To Prescribing Medication

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From the 14 June 2011 Medical News Today article

 

 shift toward more conservative medication-prescribing practices would serve patients better, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals***. The article is part of the journal’s Less Is More series.

As background, the article notes that the majority of patients under age 65 years receive at least one prescription drug annually. However, according to the authors, not every patient visit needs to result in a prescription. They point to “the recent spate of revelations of undisclosed and unexpected adverse effects of drugs in multiple therapeutic categories” as just one reason to take a more measured approach to medication usage…

…Among the steps they recommend for conservative prescribing:

• Think beyond drugs. Would other interventions help? Would a medication simply mask symptoms without treating the problem? Can a condition be prevented instead of treated? Would waiting to see if the symptoms self-resolve be wise?
• Practice more strategic prescribing. Do you have a solid understanding of medication choices? Is there a valid reason to switch to a new drug? Is it the right drug for your patient? Can you avoid using multiple medications?
• Maintain heightened vigilance regarding adverse effects. Do you check with patients about potential drug reactions? Do you teach them the warning signs? Are the drugs you’re choosing prone to withdrawal symptoms or relapse?
• Approach new drugs and new indications cautiously and skeptically. Where do you get your information about new treatments? Can you wait until a new drug has had a longer track record? Does the drug actually help resolve the core problem? Is it actually indicated for this problem? Does it deliver what it promises? Do studies tell the whole story on a drug?
• Work with patients for a more deliberative shared agenda. Can you persuade patients not to demand drugs they have seen or heard advertised? Is a patient’s noncompliance with therapy the source of the problem? Has the patient already tried this drug without success? Can you encourage healthy skepticism in your patients?
• Consider longer-term, broader effects. Would a different therapy be less likely to cause future harm? Can you find a way to make the prescribing system better?

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Information Overload in Drug Side Effect Labeling

From the 24 May 2011 ScienceDaily In the study, appearing in the May 23, 2011 issue of the Archives of Internal Medicine

ScienceDaily (May 24, 2011) — The lists of potential side effects that accompany prescription drugs have ballooned in size, averaging 70 reactions per drug, a number that can overwhelm physicians trying to select suitable treatments for their patients, according to a new study of drug labels.

In the study, appearing in the May 23, 2011 issue of the Archives of Internal Medicine, the researchers found that the average label contains 70 different side effects, with more commonly prescribed drugs averaging around 100 side effects. The upper range was remarkably high, with a single label containing as many as 525 reactions. The study involved analysis of more than 5,600 drug labels and more than half a million labeled effects.

“Having a high number of side effects on a drug’s label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits,” said lead author Jon Duke, M.D., Regenstrief Institute investigator and assistant professor of medicine at the IU School of Medicine.

“But having all these labeled side effects can overwhelm doctors who must weigh the risks and benefits when prescribing a medication. The Food and Drug Administration has taken steps to discourage such ‘overwarning,’ but at present information overload is the rule rather than the exception,” Dr. Duke said….

Journal Reference:

1. J. Duke, J. Friedlin, P. Ryan. A Quantitative Analysis of Adverse Events and ‘Overwarning’ in Drug Labeling.Archives of Internal Medicine, 2011; 171 (10): 944 DOI:10.1001/archinternmed.2011.182

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AHRQ Releases Tool to Help Consumers Reduce Medication Errors

From the press release

Three out of four Americans are not following their doctor’s advice when it comes to taking prescription medication, according to U.S. Surgeon General Dr. Regina Benjamin.  AHRQ and the National Council on Patient Information and Education have released a revised guide to help patients learn more about how to take medicines safely.  “Your Medicines: Be Smart. Be Safe” is a booklet that includes a detachable, wallet-sized card that can be personalized to help patients keep track of all medicines they are taking, including vitamins and herbal and other dietary supplements.  Available in English and Spanish, the guide includes questions that patients can ask their doctors about their medications.  Select to access a copy of the guide.  Print copies are available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.