Psychomotor effects, pharmacokinetics and safety of the orexin receptor antagonist suvorexant administered in combination with alcohol in healthy subjects

Sleep aids have a storied and often rocky relationship with alcohol. Many are known to have adverse effects when taken with alcohol, and this relationship is important to study because people most commonly consume alcohol around bedtime. This study focuses on how the orexin receptor antagonist, suvorexant, interacts with alcohol.

The study showed that suvorexant when used with alcohol reduces reaction times and cognitive function. Suvorexant and alcohol have an adverse reaction and should not be used together. Basically, alcohol enhances the effects of suvorexant to unsafe levels. However, suvorexant is shown to be perfectly safe when taken as directed.

This study illustrates the need to consider how drugs interact with the things that we ingest besides prescription medications. Alcohol is known to cause adverse effects when used with certain prescription medications, and it is always a good point to remind patients to be careful about alcohol use whenever necessary.

Sun H, Yee KL, Gill S, et al. Psychomotor effects, pharmacokinetics and safety of the orexin receptor antagonist suvorexant administered in combination with alcohol in healthy subjects. J Psychopharmacol. 2015: 29(11): 1159-1169.

Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study

Atypical antipsychotics are very well known for causing weight gain in patients. However, patients are usually dependent on these medications for the sake of their daily function, so discontinuing treatment because of weight gain is not an option. One way to alleviate this side effect is to use a medication that would cause weight loss in conjunction with using the antipsychotic. One commonly used drug that is known to cause weight loss is metformin. This study looks into the effectiveness of metformin as a weight loss agent when used with an atypical antipsychotic, with a particular focus on South Asian patients for some reason.

The study showed that metformin is an effective weight loss agent when used with an atypical antipsychotic. Patients often lost the weight that they gained from taking the antipsychotic, but they did not lose an unsafe amount of weight. It canceled out the weight gained by taking the antipsychotic while still keeping the patient very safe in all respects.

This study shows that creative drug therapies can be used to optimize the patient experience.

de Silva VA, Dayabandara M, Wijesundara H, et al. Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study. J Psychopharmacol. 2015: 29(12): 1255-1261


Anticholinergic vs Long-Acting β-Agonist in Combination With Inhaled Corticosteroids in Black Adults With Asthma

Many experts question the safety of using long acting beta agonists (LABAs) in treating asthma. Particularly, many feel as though African-Americans who use LABAs are at an increased risk for exacerbating their asthma symptoms. One idea is that allelic variation in the Arg16Gly gene could be causing pharmacogenetic variability that is disproportionately affecting African-Americans.

This study tested this hypothesis by comparing the asthmatic symptoms of African-American patients using LABAs with an inhaled corticosteroid (ICS) to  African-American patients using tiotropium and an ICS. Each patient also underwent genotyping to gauge the effect of the Arg16Gly gene. The results of the study showed that use of LABAs with an ICS did not exacerbate asthmatic symptoms any more than the use of tiotropium with an ICS. The study also showed that the Arg16Gly gene did not correlate to an increase in asthmatic symptoms, thus debunking the idea of pharmacogentic variability. Overall, the study showed that there is no difference in the worsening of asthma symptoms between LABAs and tiotropium.

This study shows the importance of researching preconceived notions about discrepancies in how certain patient populations handle medications. Without this research, some patients could receive sub-optimal therapy because of an untested yet widely accepted idea.

Wechlser ME, Yawn BP, Fuhlbrigge AL, et al. Anticholinergic vs Long Acting ß-Agonist In Combination with Inhaled Corticosteroids in Black Adults with Asthma. JAMA. 2015: 314(16): 1720-1730.  

Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013

Opioid abuse has become a ubiquitous problem in the United States, one that leads to violence, pilfering, negligence, and all of the other vices associated with drug abuse. A unique aspect of painkiller abuse is the fact that the drugs are often obtained illegally from medical professionals instead of shady street corner dealers. Studying the patterns of opioid abuse are crucial to understanding the role that healthcare providers, especially pharmacists, can play in stopping this epidemic.

This particular study produced two interestingly yet insightfully contradictory results. It found that nonmedical use of prescription opioids decreased over the duration of this study, but the prevalence of prescription opioid use disorders increased. This means that although recreational use of prescription opioids is decreasing in popularity (albeit likely more due to the increased availability of heroin in recent years than any sort of anti-drug abuse policy), the symptoms of abuse are increasing in frequency. Essentially, people are still abusing prescription opioids at increasing rates, they either do so under the veil of a false or obsolete diagnosis, or they truly have an abuse problem relating to the severity of the pain which they experience.

This study highlights the immense importance which the pharmacists and physicians have in preventing and alleviating prescription drug abuse. Abuse through medically prescribed opioids is often preventable, and can be prevented by playing an active role in counseling patients on these risky drugs. Pharmacists play an integral role in preventing drug abuse.

Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opiod use and use disorders among adults aged 16-64 years in the United States, 2003-2013. Jama. 2015: 314(14): 1468-1478.

Safety and tolerability of atomoxetine in treatment of attention deficit hyperactivity disorder in adult patients: An integrated analysis of 15 clinical trials

Atomoxetine is FDA indicated to treat attention deficit hyperactivity disorder (ADHD), and is very commonly prescribed. Because it is a common drug, it is notably important to study the potential for adverse effects, especially serious ones. This study ignores effectiveness and focuses solely on safety.

This study confirmed some of the most well known side effects such as nausea, dry mouth, decreased appetite, insomnia, marginal increases in heart rate and blood pressure, and erectile dysfunction. No side effects seen in this study were previously unknown to occur with atomoxetine. None of the subjects experienced any serious adverse effects, including suicidal thoughts.

The results of this study confirm that atomoxetine is a safe treatment option for ADHD. This study did not examine the effectiveness of the drug in treating ADHD, which often can be highly subjective when comparing ADHD to other disease states. Therefore, the main idea to be elucidated from the results of this study is that atomoxetine is a safe therapy option. If the patient feels that it is working well for them, they can continue to use it without fearing any serious adverse effects, and if other treatment options are not working, they can confidently switch to atomoxetine.

Camporeale A, Porsdal V, De Bruyckere K, et al. Safety and tolerability of atomoxetine in treatment of attention deficit hyperactivity disorder in adult patients: an integrated analysis of 15 clinical trials. J Psychopharmacol. 2015: 29(1): 3-14.  


Assessing Toxicity of Intravenous Crystalloids in Critically Ill Patients

Certain drugs can vary widely in effectiveness and toxicity when given intravenously instead of enterally and vice versa. Even water can be harmful when given intravenously. It is important to study the effects of IV administered drugs because they can be dramatic and unique within the side effect profile of the drug. Moreover, the malignancy of the adverse effects follows a vicious cycle, where more of the drug is being administered to an unhealthy patient than to a healthier patient who can also usually minimize the side effects of the drug.

Albumin and hydroxyl starch solutions were shown to increase the chance of death in patients when given IV. Treatment with these drugs should be closely monitored and alternative methods of treatment should be considered. One of the most commonly administered IV fluids is isotonic 0.9% saline solution, and its effects have been well studied for decades. This study compared the effects of this saline solution and a buffered electrolyte solution.

The study focused on the appearance of acute kidney injury (AKI), since that is a commonly occurring adverse effect for these drugs. The study showed that there is no appreciable difference between the two drugs in this respect. The value of this study is that it shows that neither of these therapies are harmful or risky treatment options.

Kellum JA, Shaw AD. Assessing Toxicity of Crystalloids in Critically Ill Patients. The Journal of the American Medical Association. 2015: 314(16): 1695-1697.