Karen M Dwyer, Penelope E Figtree, Katie Oetsch, Alok Gupta
{"title":"Cardiovascular-kidney-metabolic (CKM) syndrome.","authors":"Karen M Dwyer, Penelope E Figtree, Katie Oetsch, Alok Gupta","doi":"10.18773/austprescr.2026.026","DOIUrl":"10.18773/austprescr.2026.026","url":null,"abstract":"<p><p>Cardiovascular-kidney-metabolic (CKM) syndrome recognises the connection between metabolic conditions (particularly obesity, diabetes and metabolic dysfunction-associated fatty liver disease), chronic kidney disease and cardiovascular disease. There is a high and growing prevalence of CKM syndrome. While genetic and epigenetic factors predispose to CKM syndrome, the emergence of disease is heavily influenced by social determinants of health and individual behaviours. The pathophysiology of CKM syndrome is driven by insulin resistance, inflammation, oxidative stress and vascular dysfunction. Urinary albumin:creatinine ratio is a relatively cheap and accessible biomarker of CKM syndrome, which can be used to identify and monitor disease trajectory. Primary and secondary prevention is relevant across the life course. Healthy behaviours, including diet, physical activity, sleep and stress management are important. There are established and emerging drugs that are effective across a range of metabolic conditions and that confer reno- and cardio-protective effects. Remission may be achievable.</p>","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"79-83"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Capivasertib for locally advanced or metastatic breast cancer.","authors":"","doi":"10.18773/austprescr.2026.021","DOIUrl":"10.18773/austprescr.2026.021","url":null,"abstract":"","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"109-111"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnosis and management of irritable bowel syndrome.","authors":"Savannah Morrison, Nicholas Talley","doi":"10.18773/austprescr.2026.018","DOIUrl":"10.18773/austprescr.2026.018","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterised by recurrent abdominal pain or discomfort that is often related to defaecation or associated with a change in stool frequency or form. IBS is common in Australia and affects women more than men. The exact pathophysiology remains unclear, though it can be multifactorial and relate to gastrointestinal dysmotility, post-infection and microbial changes, and a patient's psychosocial background. A positive clinical diagnosis can be made when the Rome V criteria are met, alarm features are absent and simple screening tests (full blood count, C-reactive protein, coeliac serology) are negative. If alarm features are present, further examination, laboratory testing or imaging may be helpful in assessing for organic pathology. Management involves lifestyle and dietary modifications, and psychological and pharmacological therapies. Pharmacological therapy should be individualised to the patient's IBS subtype and symptoms. Examples of drug classes that are used include antispasmodics, osmotic laxatives, antidiarrhoeal drugs and neuromodulators (tricyclic antidepressants). There is insufficient evidence to support the use of therapies such as probiotics, faecal microbiota transplantation, and mesalamine.</p>","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"93-98"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sodium valproate: balancing benefits and risks especially in people of childbearing potential.","authors":"Dan McLaughlin","doi":"10.18773/austprescr.2026.023","DOIUrl":"10.18773/austprescr.2026.023","url":null,"abstract":"<p><p>Sodium valproate (valproate) is an approved treatment for epilepsy and bipolar disorder in Australia. It is associated with a range of adverse effects that require monitoring and may limit its use. Due to its teratogenicity, valproate should not be prescribed to women of childbearing potential. Lamotrigine or levetiracetam are preferred alternatives in epilepsy. If no alternative is suitable and valproate is prescribed, contraception should be co-prescribed. Concerns have been raised about the potential risk of neurodevelopmental disorders in children born to men taking valproate; although these findings have not been confirmed in robust studies, male patients should be informed of the potential risk.</p>","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"84-87"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bulevirtide for hepatitis D infection.","authors":"","doi":"10.18773/austprescr.2026.020","DOIUrl":"10.18773/austprescr.2026.020","url":null,"abstract":"","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"107-108"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stopping antidepressants: when and how.","authors":"Katharine A Wallis","doi":"10.18773/austprescr.2026.019","DOIUrl":"10.18773/austprescr.2026.019","url":null,"abstract":"<p><p>One in seven Australians takes an antidepressant, with around half taking them long-term (over 12 months). Unnecessarily prolonged antidepressant use should be avoided because of the risk of adverse effects. A thorough mental health and medication history should inform whether it is appropriate to attempt to stop an antidepressant. The time to stop may be when the recommended duration of therapy is complete and there is no clinical indication for continued use, or where there are adverse effects that outweigh the benefits. Stopping antidepressants abruptly may precipitate withdrawal symptoms. Withdrawal symptoms may be more likely with longer duration of therapy and with certain antidepressants, such as duloxetine, venlafaxine and paroxetine. Slowly decreasing the antidepressant dose (tapering) can help to minimise withdrawal symptoms. The optimal antidepressant tapering approach is not yet known. Tapering usually involves decreasing the antidepressant dose in smaller decrements as the dose is lowered. In patients at low risk of withdrawal symptoms, guidelines recommend 25 to 50% dose reductions over 2 to 6 weeks (e.g. sertraline 100 mg tapered at 2-weekly intervals to 50 mg, 25 mg, then stop). In patients at higher risk of withdrawal symptoms, and those who have experienced difficulty stopping, smaller dose reductions over many weeks or months, through to very low drug doses (e.g. sertraline 1 mg), may be necessary; this may require compounded or liquid 'mini doses'.</p>","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"99-103"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dual antihypertensive fixed-dose combinations approved for first-line use on the Pharmaceutical Benefits Scheme.","authors":"","doi":"10.18773/austprescr.2026.024","DOIUrl":"10.18773/austprescr.2026.024","url":null,"abstract":"","PeriodicalId":55588,"journal":{"name":"Australian Prescriber","volume":"49 3","pages":"106"},"PeriodicalIF":4.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}