Annals of Pharmacotherapy最新文献

{"title":"Mental Health Caught in the Crossfire: Selective Serotonin Reuptake Inhibitors (SSRIs), Stigma, and the Political Debate.","authors":"Cameron Lanier, Tyler Melton","doi":"10.1177/10600280251341861","DOIUrl":"https://doi.org/10.1177/10600280251341861","url":null,"abstract":"<p><p>Recent rhetoric in the media and from the United States Federal Government has called into question the effectiveness of antidepressants, namely selective serotonin reuptake inhibitors (SSRIs), among other psychiatric pharmacotherapies. Selective serotonin reuptake inhibitors have also been mentioned as potentially addictive similar to illicit narcotics and a potential threat to patients despite their status as first-line medications in treating depression. The purpose of this commentary is to review the potentially damaging effects such actions and language could have on patient perceptions of their conditions and medications, adherence, and in patients seeking mental healthcare secondary to the reinforcement of damaging stigma.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251341861"},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Literature Review of DOACs as Treatment for Confirmed or Suspected Heparin-Induced Thrombocytopenia (HIT).","authors":"Shoshana Steinmetz, Anastasiya Shor, Michelle Jakubovics","doi":"10.1177/10600280251322549","DOIUrl":"10.1177/10600280251322549","url":null,"abstract":"<p><strong>Objective: </strong>To analyze available literature on the use of direct oral anticoagulants (DOACs) in the treatment of confirmed or suspected heparin-induced thrombocytopenia (HIT).</p><p><strong>Data sources: </strong>PubMed and Embase databases were searched through December 16, 2024, to identify studies assessing DOAC use in the treatment of acute confirmed or suspected HIT.</p><p><strong>Study selection and data extraction: </strong>Included studies analyzed use of apixaban, dabigatran, edoxaban, or rivaroxaban in patients with confirmed or suspected HIT.</p><p><strong>Data synthesis: </strong>Ten studies including 275 patients met the inclusion criteria. Eight were retrospective cohort studies and 2 were prospective. No randomized control trials were identified. A 4Ts score was reported for 259 patients; an antibody immunoassay was reported for 149 patients; and a serotonin release assay was reported for 109 patients. Eight, 6, and 2 studies reported use of rivaroxaban, apixaban, and dabigatran, respectively. Thrombosis rates ranged from 0% to 8.3%, 0% to 13.7%, and 0% to 2.5% for rivaroxaban, apixaban, and dabigatran respectively. Major bleeding was reported in 1 patient receiving rivaroxaban.</p><p><strong>Relevance to patient care and clinical practice: </strong>The 2018 American Society of Hematology HIT guidelines conditionally recommend DOAC use due to very low certainty of effects. Direct oral anticoagulants (DOACs) are an attractive treatment option for acute HIT due to ease of administration and reduced need for monitoring. Analysis of the recently published relevant data can support and guide appropriate use of DOACs in these patients.</p><p><strong>Conclusions: </strong>This systematic review strengthens previously published evidence that DOACs are likely a safe and effective treatment for confirmed or suspected HIT. Study design, small study size, and varying diagnostic criteria reduce data certainty.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251322549"},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an Alternative Approach to Managing Diabetic Ketoacidosis: Combination Rapid-Acting and Basal Subcutaneous Insulin (CRABI-DKA).","authors":"Francisco Ibarra, Mallory Cruz, Brian Chinnock, Caleb Sunde, Danielle Campagne, Mia Uller","doi":"10.1177/10600280251331967","DOIUrl":"https://doi.org/10.1177/10600280251331967","url":null,"abstract":"<p><strong>Background: </strong>Although guidelines recognize the utility of subcutaneous (SQ) insulin regimens in the management of mild to moderate diabetic ketoacidosis (DKA), the need to administer SQ insulin every 1-2 hours may discourage their use due to frequent lab testing and admission to higher level of care units.</p><p><strong>Objective: </strong>The purpose of this retrospective cohort study was to compare the proportion of patients whose mild to moderate DKA resolved within 12 hours after receiving the new SQ insulin order set and the institution's intravenous (IV) insulin infusion order set.</p><p><strong>Methods: </strong>The SQ order set included single doses of glargine (0.2 units/kg) and lispro (0.2 units/kg) upon therapy initiation, followed by lispro (0.1-0.2 units/kg) given every 3 hours until DKA resolution. The IV order set included a nurse-managed titratable infusion. Glucose and labs were checked every 3 hours in the SQ group, whereas glucose was checked hourly and labs were checked every 2 hours in the IV group. Patients were managed on units with a RN to patient ratio of 1:4-5 and 1:2-3 in the SQ and IV groups, respectively.</p><p><strong>Results: </strong>The percentage of patients whose DKA resolved within 12 hours was 78% in the IV group and 90% in the SQ group (<i>P</i> = 0.1). The time to DKA resolution and rates of hypoglycemia and hypokalemia were comparable between the groups.</p><p><strong>Conclusion and relevance: </strong>Our study highlights the utility of combining rapid-acting and basal SQ insulin in the management of DKA and adds to the limited literature evaluating this approach.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251331967"},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Association Between Rocuronium Administration and Clinical Outcomes in Patients With Moderate-To-Severe Acute Respiratory Distress Syndrome: A Retrospective Cohort Study\".","authors":"Venkata Dileep Kumar Veldi, Ranjana Sah","doi":"10.1177/10600280251338172","DOIUrl":"https://doi.org/10.1177/10600280251338172","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251338172"},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Concomitant Use of Diltiazem or Verapamil With Direct Oral Anticoagulants: A Meta-analysis.","authors":"Kazuhiko Kido, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi","doi":"10.1177/10600280251323955","DOIUrl":"https://doi.org/10.1177/10600280251323955","url":null,"abstract":"<p><strong>Background: </strong>Diltiazem and verapamil are combined p-glycoprotein and moderate CYP3A4 inhibitors which significantly increase the concentrations of direct oral anticoagulants (DOACs) and may increase the risks of bleeding. Multiple real-world studies compared the concomitant therapy of diltiazem/verapamil and DOACs versus the DOAC monotherapy groups, but their main findings were contradictory.</p><p><strong>Objective: </strong>To evaluate the risks of bleeding and stroke between the concomitant therapy of diltiazem/verapamil and DOACs and DOAC monotherapy.</p><p><strong>Methods: </strong>A meta-analysis was performed to compare the concomitant therapy of diltiazem/verapamil and DOACs versus DOACs. Database searches through November 16, 2024 were performed using MEDLINE and Google Scholar. The primary outcome was major bleeding. The secondary outcomes included stroke or systemic embolism and gastrointestinal bleeding.</p><p><strong>Results: </strong>A total of 6 studies were included in this meta-analysis. It showed that the concomitant therapy of DOAC and diltiazem/verapamil was significantly associated with increased risks of major bleeding (odds ratio [OR] = 1.38; 95% CI = 1.24, 1.54; <i>P</i> < 0.01; <i>I</i>² = 0%) and gastrointestinal bleeding (OR = 1.19; 95% CI = 1.03, 1.37; <i>P</i> = 0.01; <i>I</i>² = 0%) compared with the DOAC monotherapy group. The concomitant therapy group was also significantly associated with the lower risk of stroke or systemic embolism compared with the DOAC monotherapy group (OR = 0.83; 95% CI = 0.73, 0.93; <i>I</i>² = 0%).</p><p><strong>Conclusion and relevance: </strong>This meta-analysis found that the concomitant therapy of DOACs with diltiazem/verapamil increases the risks of bleeding outcomes compared with the DOAC monotherapy group.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251323955"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Monotherapy and Combination Therapy With Antipsychotic Medications for Intensive Care Unit Delirium: A Retrospective Cohort Study.","authors":"Anh Nguyen, Justin Chang, Timothy Allison-Aipa, Paul Albini","doi":"10.1177/10600280251322199","DOIUrl":"https://doi.org/10.1177/10600280251322199","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic medications continue to be frequently prescribed by clinicians in the intensive care unit (ICU) for delirium, despite inconclusive data.</p><p><strong>Objective: </strong>To determine if using a combination of antipsychotics reduces the time patients spend in delirium compared with monotherapy.</p><p><strong>Methods: </strong>This was a single-center, retrospective, cohort medical record review of patients who scored positive on Confusion Assessment Method for the ICU (CAM-ICU) and received antipsychotic therapy. Patients were excluded if they received any antipsychotics prior to hospital admission or had a Richmond Agitation-Sedation Scale (RASS) scores of -4 or -5 at the time of CAM-ICU assessment. The primary outcome was duration of delirium. The secondary outcomes included ICU length of stay (LOS), hospital LOS, overall mortality, occurrence of adverse events (AEs), and whether antipsychotics were continued at hospital discharge.</p><p><strong>Results: </strong>A total of 84 patients were included, of these 45 and 39 received monotherapy and combination therapy, respectively. Median Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly higher in the monotherapy group (18 vs 13, <i>P</i> = 0.006). Median duration of delirium was not significantly different between the monotherapy and combination therapy groups (8 vs 8 days, <i>P</i> = 0.932). Median ICU and hospital LOS, and occurrence of AEs were not significantly different. A significant difference in mortality was found between monotherapy and combination therapy (31% vs 10%, <i>P</i> = 0.02). Antipsychotics were continued at hospital discharge in 64% of the monotherapy and in 44% of the combination therapy group.</p><p><strong>Conclusion and relevance: </strong>In patients with ICU delirium, there was no difference in duration of delirium among patients receiving monotherapy compared with combination therapy with antipsychotics, though they may be sicker and have a higher mortality. Patients commonly remain on antipsychotics at hospital discharge, the implications of which warrant further study.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251322199"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Cholinesterase Inhibitor Medication on QTc Interval in Memory Clinic Patients.","authors":"Hanna Karita Isotalo, Joanna Karoliina Lehtovaara, Laura Linnea Ekblad, Maria Susanna Nuotio, Ville Lauri Johannes Langén","doi":"10.1177/10600280251328530","DOIUrl":"https://doi.org/10.1177/10600280251328530","url":null,"abstract":"<p><strong>Background: </strong>Cholinesterase inhibitors (ChEIs)-donepezil, rivastigmine, and galantamine-are beneficial in treating Alzheimer disease (AD). However, due to their impact on extra-cerebral acetylcholine signaling, concerns about cardiac adverse effects, including QT interval prolongation, persist. Despite this, evidence-based guidelines for electrocardiogram (ECG) monitoring during ChEI treatment are lacking, and prior studies on ChEIs and corrected QT intervals (QTc) yield inconsistent findings.</p><p><strong>Objective: </strong>This study aimed to investigate the association between ChEI use and changes in QTc intervals among older adults.</p><p><strong>Methods: </strong>We collected retrospective data from first-time visitors to the geriatric memory clinic of Turku City Hospital in 2017 and 2019. We included patients who were newly prescribed ChEIs and had ECG data available (n = 126, mean age 81.1 years, 56.3% female). QTc prolongation was defined as ≥460 ms in females and ≥450 ms in men. Paired <i>t</i> tests compared QTc means before and during ChEI use, and McNemar tests analyzed changes in the proportion of prolonged QTc.</p><p><strong>Results: </strong>Mean ± SD QTc (ms) before versus during ChEI use was: 420.8 ± 24.0 versus 423.9 ± 28.0 (<i>P</i> = .13) for donepezil; 416.0 ± 20.4 versus 416.5 ± 26.1 (<i>P</i> = .92) for galantamine; 416.1 ± 22.3 versus 409.6 ± 20.1 (<i>P</i> = .30) for rivastigmine; and 419.7 ± 23.4 versus 421.5 ± 27.3 (<i>P</i> = .34) for all ChEIs. Prolonged QTc occurred in 7.9% of patients before versus 12.7% during ChEI use (<i>P</i> = .21).</p><p><strong>Conclusion and relevance: </strong>We found no statistically significant association between ChEI use and QTc interval prolongation or an increased proportion of pathological QTc values during ChEI treatment. Larger studies are warranted to establish evidence-based recommendations on ECG monitoring during ChEI medication.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251328530"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentinoïds and Hip Fracture: A Pharmacovigilance Comparative Study Between Gabapentin and Pregabalin.","authors":"Jean-Louis Montastruc","doi":"10.1177/10600280251336244","DOIUrl":"https://doi.org/10.1177/10600280251336244","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251336244"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Courses of Fidaxomicin Followed by Oral Vancomycin and the Effect on Recurrence of <i>Clostridioides difficile</i> Infections.","authors":"Irene-Constantina Papamanolis, Nicholas Stornelli, Nathan Everson, Zayd Ahmad, Meghan Kamrada, Ellen Rachel Lockhart, Lauren McDaniel","doi":"10.1177/10600280251332946","DOIUrl":"https://doi.org/10.1177/10600280251332946","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) causes a significant national health care burden. Literature has demonstrated lower rates of CDI recurrence with fidaxomicin compared with oral vancomycin. However, patients are sometimes switched to oral vancomycin before completing a fidaxomicin course.</p><p><strong>Objective: </strong>The objective of this study is to evaluate rates of CDI recurrence in full courses of fidaxomicin versus partial courses of fidaxomicin followed by a switch to oral vancomycin.</p><p><strong>Methods: </strong>In this single-center, retrospective, cohort study of adults with CDI, patients were screened for inclusion if they received either a full 10-day course of fidaxomicin or partial course of fidaxomicin followed by a switch to oral vancomycin. The primary outcome was the rate of CDI recurrence within 30 days after completion of initial therapy determined by a positive CDI test and initiation of treatment.</p><p><strong>Results: </strong>Ninety-nine patients received a full course of fidaxomicin, and 95 patients received a partial course of fidaxomicin followed by oral vancomycin. Mean age was lower in the full course group compared with the partial course (65.3 years vs 71.5 years, <i>P</i> < 0.002). <i>Clostridioides difficile</i> infection recurrence occurred in 5.1% of the full course group and 7.4% of the partial therapy group (<i>P</i> = 0.503) at 30 days and 13.1% versus 14.7% (<i>P</i> = 0.747) at 90 days. <i>Clostridioides difficile</i> infection-related readmissions at 30 days were similar in the full course and partial course groups (7.1% vs 4.2%, <i>P</i> = 0.389).</p><p><strong>Conclusion and relevance: </strong>Partial courses of fidaxomicin followed by oral vancomycin had similar 30-day CDI recurrence compared with full course fidaxomicin.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251332946"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupilumab Use in Eosinophilic Esophagitis: Analysis of the FDA Adverse Event Reporting System Database.","authors":"Michael B Andrews, Hiba Khan, Douglas G Adler","doi":"10.1177/10600280251336243","DOIUrl":"https://doi.org/10.1177/10600280251336243","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251336243"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}