NMA: Nonprescription Medicines Academy

Quick Takes

August 29th, 2012

  • Once ragweed pollens begin surfacing in mid-August, many people will mistake their seasonal symptoms for a cold instead of allergic rhinitis (“hay fever”), according to a news brief from the American College of Allergy, Asthma and Immunology (ACAAI). This is especially true for adults who develop allergic rhinitis later in life. People who experience symptoms such as runny nose, sneezing, and nasal congestion that persist for longer than 2 weeks should be encouraged to consult with a primary care provider or allergist. Patients with known ragweed allergy should begin taking antihistamines or other medication before symptoms start (i.e., before ragweed blooms in early to mid-August) and continue until a few weeks after the first frost. Patient-directed information about allergic rhinitis is available on the ACAAI website at http://www.acaai.org/allergist/allergies/Types/rhinitis/Pages/default.aspx.
  • The cover story of the September 2012 issue of Consumer Reports magazine details “Ten Surprising Dangers of Vitamins and Supplements.” Among the points made in the article are that dietary supplements are not risk-free, and none have been proved to cure major diseases. The article also explains that products assumed to be “natural” often contain synthetic ingredients, while some dietary supplements have been found to be spiked with prescription drugs. The article was compiled from interviews with experts, published research, and a Consumer Reports analysis of reports of serious adverse events submitted to the Food and Drug Administration (obtained through a Freedom of Information Act request). The text is available online at http://www.consumerreports.org/cro/magazine/2012/09/10-surprising-danger....
  • The popular proton pump inhibitor esomeprazole (Nexium) could become available without a prescription as early as 2014, according to information released by Pfizer Inc. Under the terms of an agreement with AstraZeneca, Pfizer will acquire the exclusive global rights to market Nexium for approved OTC indications in the United States, Europe and the rest of the world. A New Drug Application filing for OTC Nexium in 20-mg, delayed-release capsules is targeted for the first half of 2013.
  • A retrospective cohort study designed to address uncertainties regarding the safety and effectiveness of zoster vaccine in patients with immune-mediated diseases found no short-term increase in the risk for varicella or herpes zoster. The study population included 463,541 Medicare beneficiaries 60 years of age or older with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease; 18,683 patients (4.0%) received the zoster vaccine during the study. The overall crude herpes zoster incidence rate was 7.8 cases per 1,000 person-years (95% CI, 3.7–16.5) within 42 days after vaccination, vs 11.6 cases per 1,000 person-years (95% CI, 11.4–11.9) among the unvaccinated. No case of herpes zoster or varicella occurred among 633 patients exposed to biologics at the time of vaccination or within the subsequent 42 days. Zoster vaccine was associated with a lower herpes zoster incidence rate over a median of 2 years of follow-up (HR, 0.61; 95% CI, 0.52–0.71). (JAMA. 2012;308:43-9.)
  • In a meta-analysis of pooled participant-level data from 11 double-blind, randomized, controlled trials, high-dose vitamin D supplementation (≥800 IU daily) was somewhat favorable in the prevention of hip fracture and any nonvertebral fracture in persons 65 years of age or older. The total study population included 31,022 persons (mean age 76 years; 91% women) with 1,111 incident hip fractures and 3,770 nonvertebral fractures. Participants who were randomly assigned to receive vitamin D (daily, weekly, or every 4 months) had a nonsignificant 10% reduction in the risk of hip fracture (HR, 0.90; 95% CI, 0.80–1.01) and a 7% reduction in the risk of nonvertebral fracture (HR, 0.93; 95% CI, 0.87–0.99) compared with participants assigned to control groups. Reduction in the risk of fracture was shown only at the highest intake level (median 800 IU daily; range, 792–2000), with a 30% reduction in the risk of hip fracture (HR, 0.70; 95% CI, 0.58–0.86) and a 14% reduction in the risk of any nonvertebral fracture (HR, 0.86; 95% CI, 0.76–0.96). (N Engl J Med. 2012;367:40-9.)
  • Training in mindfulness meditation or moderate-intensity exercise may be effective strategies for reducing the incidence, duration, and severity of acute respiratory infection (ARI) illness, based on results from 149 community-recruited adults 50 years of age or older. Participants were randomized to an 8-week mindfulness-based stress reduction program, an 8-week program of weekly 2.5-hour group exercise training plus 45 minutes per day of home exercise (primarily brisk walking or jogging), or observational control. During the ensuing cold and influenza season, there were 27 ARI episodes and 257 days of ARI illness in the meditation group (n = 51), 26 episodes and 241 illness days in the exercise group (n = 47), and 40 episodes and 453 days in the control group (n = 51). Mean global severity was significantly lower in the meditation group (P = 0.004) and trended toward being lower for the exercise group (P = 0.16) vs the control group. Total days of illness (duration) trended toward being lower for both the meditation group and the exercise group (P = 0.034 and 0.032, respectively). Participants in the control group had 67 ARI-related missed days of work, compared with 32 in the exercise group (P = 0.041) and 16 in the meditation group (P <0.001). (Ann Fam Med. 2012;10:337-46.)
  • Among 237 adults 35 years of age or older with prediabetes, 9 months of treatment with curcumin—the principal curcuminoid found in the spice turmeric (Curcuma longa Linn.)—substantially and significantly prevented the development of type 2 diabetes. At 12 months, 19 subjects in the placebo group (16.4%) were diagnosed with type 2 diabetes, vs none in the curcumin-treated group (p <0.001). Curcumin treatment also appeared to improve overall function of β cells. Adverse effects in the curcumin-treated group were limited to minor symptoms such as itching, constipation, and vertigo. (Diabetes Care. 2012 Jul 6. [Epub ahead of print])
  • An often-cited estimate of typical weight gain following smoking cessation (2.9 kg, or approximately 6 lb) is too low, based on a meta-analysis of 62 trials that tested first-line interventions for smoking cessation (nicotine replacement therapy, bupropion, varenicline) as well as trials aimed at limiting post-cessation weight gain. The average increase in body weight at 1 year in successful quitters was 4.67 kg (approximately 10 lb), with the majority of weight gain occurring within the first 3 months. However, there was a large variation in weight change, with about 16% of quitters losing weight and 13% gaining more than 10 kg (approximately 22 lb). (BMJ. 2012 Jul 10;345:e4439.)