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Higher-dose antiepileptics increase risk of congenital malformations
Study shows that several common antiepileptic drugs pose the risk of major congenital malformations and that risk increases dose-dependently.
The risk of major congenital malformations increases dose-dependently with 4 common antiepileptic drugs, according to the results of a study published online June 5 in The Lancet Neurology. However, “the risk of major congenital malformations is influenced not only by type of antiepileptic drug, but also by dose and other variables, which should be taken into account in the management of epilepsy in women of childbearing potential,” the authors wrote.
Researchers prospectively evaluated pregnancy outcomes using data from the International Registry of Antiepileptic Drugs and Pregnancy (EURAP), which represents a collaboration of physicians from 42 countries. Researchers evaluated 1,402 patients who were prescribed carbamazepine, 1,280 prescribed lamotrigine, 1,010 prescribed valproic acid, and 217 on phenobarbital at the time of conception and found an increase in malformations with higher doses for all drugs.
A multivariable analysis, which included 10 covariates in addition to treatment with antiepileptic drugs showed that the risk of malformations was greater with a parental history of major congenital malformations (OR=4·4; 95% CI, 2.06–9.23). With regard to drug treatment, researchers noted the lowest rates of malformation with less than 300 mg per day lamotrigine and less than 400 mg per day carbamazepine. Risks of malformation were significantly higher with valproic acid and phenobarbital at all investigated doses, and with carbamazepine at doses greater than 400 mg per day compared with lamotrigine monotherapy at doses less than 300 mg per day.
“Our findings suggest that many women can enter pregnancy at comparatively low doses and maintain seizure control. Our study gives the prescriber the possibility of assessing, before pregnancy, how teratogenic risks with an individual woman's treatment compare with the risks associated with alternative treatments at various doses,” the researchers stated.
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.
