Small Doses: Pharmacy News Featuring Opioids, Ketamine, and More


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In this entry of Small Doses, we're bringing you news on the opioid crisis, drugs linked to dementia, and more! 

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Too Many Older Americans Taking Drug Linked to Dementia

A drug used frequently to treat overactive bladder is linked to problems with cognition and an increased risk of dementia. Despite this, the drug, oxybutynin, is being prescribed to millions of older people in the United States, according to a study released at the European Association of Urology conference in London.

Researchers led by Daniel Pucheril, MD, examined six years of statistics from the U.S. National Ambulatory Medical Care Survey and focused on about 2,600 patients aged 65 and over who were given prescriptions for an overactive bladder; 27% of those prescriptions were for oxybutynin. Only 9% of patients taking oxybutynin had a neurological exam, even though the FDA recommends monitoring for signs of cerebral problems, the researchers pointed out. Some of this overuse may be because most Medicare Part D plans require that patients try and fail with oxybutynin before they are eligible for the newer generation antimuscarinic medications.


Vaccination Reduces a Child’s Risk of Dying from Flu

A CDC study has found that being vaccinated against flu reduced the risk of death associated with flu in kids with other medical conditions by 51%. Vaccination cuts the risk of death in otherwise healthy kids by 65%.

This finding is based on data from four flu seasons between 2010 and 2014. During that time, there were 358 cases of children’s death that were confirmed to be associated with flu. Researchers estimated how effective flu vaccine was at preventing flu-related deaths by comparing vaccination status of the children who died to comparison groups. Comparison groups were obtained from national surveys and a database of commercial insurance claims.

The study’s findings underscore the importance of having all children aged 6 months and older vaccinated against flu, as the CDC and the American Academy of Pediatrics recommends.

Flannery B, Reynolds SB, Blanton L, et al.: Influenza vaccine effectiveness against pediatric deaths: 2010-2014. Pediatrics. Published Online April 03, 2017. doi: 10.1542/peds.2016-4244



Opioid Prescriptions Went Down in States with Drug Monitoring Mandates

Almost every state has a prescription drug monitoring program (PDMP) in place, which has the goal of addressing the prescription opioid epidemic. But as of 2014, prescribers were not participating in the programs in large numbers, which lead some states to mandate that prescribers register with their state’s PDMP. A study published in Health Affairs has found that creating these mandates is an effective way to boost safer prescribing patterns. The authors analyzed aggregate Medicaid drug utilization data. They found that state mandates for prescriber registration or use of PDMPs that were adopted between 2011 and 2014 were associated with a reduction of 9 to 10% in the adjusted numbers of Schedule II opioid prescriptions and in the amounts of Medicaid spending on these prescriptions. This reduction was largely associated with mandated registration and not with mandated use rules, which were largely limited in scope or strength before 2015. Mandating registration with and use of PDMPs is “an effective and relatively low-cost policy,” the authors said.

Wen H, et al.: States with prescription drug monitoring mandates saw a reduction in opioids prescribed to Medicaid enrollees. Health Affairs. April 2017 (36) 4733-4741. doi: 10.1377. 



British Study Recommends Controlled Use of Ketamine for Severe Depression

Ketamine, legally used in anesthesiology and illegally used as a party drug, is safe and effective for use as a treatment for severe depression that has not been helped by other treatments. This is the finding of a review in The Lancet Psychiatry conducted by a team from Oxford. The authors note that ketamine should be used only under controlled conditions and warned against “ketamine clinics” that have popped up in the United States, according to a Reuters report. Their review concluded with recommendations for “oversight bodies that would support safe, effective, and ethical use of ketamine in depression.” Doses used in trials of ketamine for severe depression were around 80 mg and given once a week in a monitored setting. The American Psychiatric Association has issued a consensus statement on the appropriate use of ketamine in patients who do not respond to regular antidepressants.

Singh I, Morgan C, Curran V, et al.: Ketamine treatment for depression: Opportunities for clinical innovation and ethical foresight. Lancet Psych. doi:

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