NMA: Nonprescription Medicines Academy

Quick Takes

December 14th, 2012

  • Nonprescription medications—analgesics in particular—continue to be an important source of toxic drug exposures, based on an analysis of data from the American College of Medical Toxicology case registry (ToxIC, the Toxicology Investigators Consortium). ToxIC compiles suspected and confirmed toxic exposure cases cared for at the bedside by medical toxicologists at participating sites. Pharmaceutical overdose was the most common reason for consultation during 2011, accounting for 48% of cases. Aspirin, acetaminophen, and NSAIDs were involved in 21% of those cases; acetaminophen was responsible for all eight deaths attributed to analgesics. (J Med Toxicol. 2012;8:360-77.)
  • In the largest study ever conducted on the clinical effects of echinacea—encompassing 673 healthy adults recruited on the campus of Cardiff University in Wales—participants who consumed an alcoholic extract of fresh echinacea (Echinaforce, made from E. purpurea, 95% aerial parts and 5% roots) three times daily for 4 months had significantly fewer cold episodes, fewer days with colds, and fewer colds that required additional medication (e.g., acetaminophen, ibuprofen), compared with participants who consumed placebo. Significantly fewer nasal swab samples from the echinacea group contained evidence of viral infection (influenza virus, coronavirus, metapneumovirus, respiratory syncytial virus, or parainfluenza virus) as compared to the placebo group (24 vs 47, respectively; P <0.05). The author speculated that this finding may preliminarily indicate clinical antiviral activity. (HerbalGram. 2012;96:28-9.)
  • Cranberry products cannot currently be recommended for the prevention of urinary tract infections (UTIs), according to a recently updated Cochrane systematic review that included 24 trials with 4,473 participants. When compared with placebo, water, or no treatment, cranberry products did not significantly reduce the occurrence of symptomatic UTI overall or for any the subgroups: women with recurrent UTIs, older people, pregnant women, children with recurrent UTI, cancer patients, or people with neuropathic bladder or spinal injury. Many studies reported low compliance and a large number of dropouts/withdrawals, attributed mainly to palatability/acceptability of cranberry juice in particular. (Cochrane Database Syst Rev. 2012 Oct 17;10:CD001321)
  • A Wall Street Journal article titled “Why Your Heartburn Drugs Don’t Work” discusses the latest thinking about non-erosive reflux disease (NERD). The November 12, 2012, article states that people with NERD are 20% to 30% less likely to get relief from treatment with proton pump inhibitors, histamine H2-receptor antagonists, or antacids. Full text is available at http://online.wsj.com/article/SB1000142412788732389470457811503169927801....
  • Fasting before routine lipid testing is largely unnecessary, according to a cross-sectional examination of laboratory data from a large community-based cohort. The mean levels of total cholesterol and high-density lipoprotein cholesterol differed little among 209,180 individuals (111,048 women and 98,132 men) with fasting intervals from 1 hour to more than 16 hours. The mean calculated low-density lipoprotein cholesterol levels showed slightly greater variations of up to 10% among groups of patients with different fasting intervals, and the mean triglyceride levels showed variations of up to 20%. (Arch Intern Med. 2012 Nov 12. [Epub ahead of print])
  • Data presented at the 22nd Annual Meeting of the American Association of Hip and Knee Surgeons support the use of aspirin as an alternative to warfarin for preventing pulmonary embolus following joint replacement surgery in healthy patients. In a study that compared outcomes for 26,415 patients who underwent joint replacement surgery between 2000 and 2011, the overall rate of pulmonary embolism was significantly lower among the 1,824 patients who received aspirin prophylaxis (0.2%) than among the 9,028 matched controls who received warfarin (1.0%). Aspirin prophylaxis also was associated with a lower rate of bleeding and wound complications over 90 days of follow-up.
  • Results of a cross-sectional study presented at the 2012 Joint Meeting of the American Academy of Ophthalmology and the Asia-Pacific Academy of Ophthalmology suggest that a higher total intake of calcium and iron may be associated with increased presence of glaucoma. The study used data from 3,598 men and women 40 years of age or older who participated in the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Adjusted odds of glaucoma increased with higher quintile intakes of calcium and iron compared with the lowest quintile intake.
  • A Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG) supports making oral contraceptives available on a nonprescription basis. Among the potential concerns discussed in the document are payment for pharmacist services and the possibility of pharmacists inappropriately refusing to provide oral contraceptives. The document is available on the ACOG website at http://www.acog.org/Resources_And_Publications/Committee_Opinions/Commit....
  • In a new policy statement, the American Academy of Pediatrics (AAP) Committee on Adolescence recommends that pediatricians provide teenagers with prescriptions for levonorgestrel 1.5 mg emergency contraception (Plan B, Plan B One Step, or Next Choice) to have on hand in case of future need (i.e., advance provision). The statement also encourages pediatricians to advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers. The statement is available on the AAP website at http://pediatrics.aappublications.org/content/130/6/1174.full.
  • Two out of three American adults (68%) take nutritional or dietary supplements, based on responses to the 2012 Council for Responsible Nutrition (CRN) Consumer Survey on Dietary Supplements. The majority of those adults (76%) classify themselves as “regular” users, as opposed to occasional users (18%) or seasonal users (6%). Survey participants were most likely to report using multivitamins (52%), omega-3/fish oil (21%), vitamin D (20%), vitamin C (19%), or calcium (17%).
  • A study conducted by the Institute for Pharmaceutical Outcomes and Policy at the University of Kentucky College of Pharmacy is the first to provide empirical evidence that pseudoephedrine sales are correlated with the clandestine manufacture of methamphetamine. County-level data from 2010 revealed a significant association between greater pseudoephedrine sales and greater numbers of laboratories. For a typical county, an increase in pseudoephedrine sales of 13 g per 100 residents was associated with approximately one additional laboratory. (JAMA. 2012;308:1524-6.)
  • In an online survey conducted on behalf of St. Joseph Health Products, nearly half of the 1,000 participants were unaware that patients with hypertension should avoid using decongestants. The survey was conducted from May 19 to June 13, 2012, and included men and women 45 to 64 years of age who either had high blood pressure or purchased nonprescription cough and cold medications for someone with high blood pressure.
  • Cetirizine HCl (Zyrtec) and proton pump inhibitors are among the products for which potential signals of serious risks/new safety information were identified in the FDA Adverse Event Reporting System database during the period April to June 2012. Cetirizine is being evaluated for a possible association with oculogyric crisis; proton pump inhibitors are being evaluated for a possible association with pneumonia. Additional information is available at http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveil....
  • Healthy young adults can improve their working memory even further by increasing their intake of omega-3 polyunsaturated fatty acids, according to a small study conducted at the University of Pittsburgh. The 11 study participants (all 18 to 25 years of age) completed a standard working memory test (the “n-back test,” in which they were shown a series of letters and numbers and had to keep track of what appeared one, two, and three times prior) both before and after taking omega-3-acid ethyl esters (Lovaza) 2 g daily for 6 months. Test performance improved significantly at the end of the 6-month supplementation period (P = 0.04). (PLoS One.2012;7:e46832. Available at http://www.plosone.org/article/info:doi/10.1371/journal.pone.0046832#pon....)
  • During the 2010 pertussis epidemic in California—the largest in more than 60 years—children with pertussis were significantly less likely to have received all five doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, compared with controls (OR, 0.11; 95% CI, 0.06–0.21). Children with pertussis also were less likely than controls to have received their fifth dose within the prior 12 months (OR, 0.02; 95% CI, 0.01–0.04). The results are consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine. (JAMA. 2012; 308:2126-32.)
  • The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has voted unanimously to recommend that all pregnant women receive the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during the late-second or third trimester of every pregnancy. This builds on a previous recommendation made by the ACIP in June 2011 to administer Tdap during pregnancy only to women who have not previously received Tdap. If not administered during pregnancy, Tdap should be administered immediately postpartum, before leaving the hospital or birthing center.