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Cotrimoxazole tied to bleeding in older patients on warfarin
In older patients treated with warfarin, the use of cotrimoxazole is associated with a higher risk of upper gastrointestinal tract hemorrhage than other common antibiotics, according to research published in the April 12 issue of the Archives of Internal Medicine, as reported by HealthDay News.
In older patients treated with warfarin, the use of cotrimoxazole is associated with a higher risk of upper gastrointestinal (UGI) tract hemorrhage than other common antibiotics, according to research published in the April 12 issue of the Archives of Internal Medicine, as reported by HealthDay News.
Hadas D. Fischer, MD, of the University of Toronto, Toronto, Ontario, Canada, and colleagues analyzed data from a nested case-control study with 134,637 patients, aged 66 or older, who were treated with warfarin for at least 180 days. Of this group, 2,151 cases were hospitalized for UGI tract hemorrhage, and were matched to controls.
Researchers found that cases hospitalized for UGI tract hemorrhage were substantially more likely than controls to have recently been treated with cotrimoxazole (adjusted OR=3.84; 95% CI, 2.33–2.95).
Treatment with ciprofloxacin also was associated with higher risk (adjusted OR=1.94; 95% CI, 1.28–2.95), but amoxicillin; ampicillin; nitrofurantoin; and norfloxacin were not to a significant degree. Cotrimoxazole prescription was associated with a higher risk compared with amoxicillin or ampicillin (OR=2.80; 95% CI, 1.48–5.32).
“Our observations suggest that clinicians should consider antibiotics other than cotrimoxazole in patients receiving warfarin,” the authors concluded. “If alternatives are inappropriate, close monitoring of anticoagulation control is necessary, and temporary reductions in the dosage of warfarin may be required.”
Two co-authors disclosed past employment relationships with Bayer and Pfizer Global Pharmaceuticals.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.
