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Abstract

AbstractSmall AED suicide riskAntiepileptic drugs (AEDs) are associated with a small increase in the risk of suicidal thoughts, the MHRA has warned.In the latest Drug Safety Update (2008;2:Issue 1) the MHRA says that, compared with placebo, AEDs are associated with an additional two cases of suicidal thoughts and behaviour per 1000 patients (0.43 vs 0.22 per cent). This may occur as early as one week after starting treatment. It is unclear whether the risk varies among AEDs.Also in this issue, the MHRA warns of an increased risk of tumour progression and reduced survival in patients with cancer treated with recombinant erythropoietin. Other topics include the use of lenalidomide (Revlimid) and thalidomide for multiple myeloma; new restrictions on the use of moxifloxacin (Avelox) due to adverse effects; and a reminder that metronidazole should be administered orally, not by intravenous injection, for the treatment of C. difficile‐associated diarrhoea.Low‐fat diet least effective option?A low‐fat diet is associated with less weight loss and less favourable metabolic changes over two years than a low‐carbohydrate (Watkins) diet or a Mediterranean diet in 322 moderately obese patients (mean BMI 30kg per m2; N Eng J Med 2008;359:229–41).Estimated energy intake was similar for all diets. Mean weight loss in all randomised patients was 2.9kg for the low fat diet, 4.4kg for the Mediterranean diet and 4.7kg for the low‐carbohydrate diet. The low‐carbohydrate diet was associated with greater increases in HDL‐cholesterol and greater reductions in triglycerides and total cholesterol/HDL‐C ratio compared with the low‐fat diet. Among people with diabetes, fasting plasma glucose and insulin resistance were decreased only in those assigned to the Mediterranean diet, and only the low carbohydrate diet significantly decreased HbA1c.Stopping post‐MI statinsPatients who stop taking a statin first prescribed after an acute MI almost double their risk of death compared with nonusers, a new study shows (Eur Heart J; published online 29 July 2008; doi: 10.1093/eurheartj/ehn346).The analysis of 9939 MI survivors in the General Practice Research Database showed that, compared with patients who had never used a statin, the risk of death was unchanged for those previously taking a statin who continued treatment after MI. The risk was reduced by 28 per cent for those who started a statin post‐MI and continued it but, in those who started a statin but then stopped it, the hazard ratio for death was 1.88 (CI 95% 1.13‐3.07).Stopping control medication (aspirin, beta‐blockers or proton pump inhibitors) did not alter the risk of death.Smoking quit rates with NRT and vareniclineDifferences in quit rates between nicotine replacement therapy (NRT) and varenicline (Champix) are small, according to a multinational study (Thorax 2008;63:717–24). The trial compared transdermal NRT (21mg to 7mg per day over 10 weeks) with varenicline (1mg twice daily for 12 weeks). Over the final four weeks of treatment, the abstinence rate was significantly higher with varenicline (56 vs 43 per cent). After one year, the four‐week abstinence rates were 26 and 20 per cent respectively (p = 0.056) and seven‐day point prevalence abstinence rates at 6 or 12 months were not significantly different. Varenicline reduced craving, withdrawal symptoms and smoking satisfaction compared with NRT but at the cost of a higher incidence of nausea (37 vs 10 per cent).Azithromycin goes OTCThe MHRA has announced that azithromycin will be available without prescription for the treatment of Chlamydia infection.Under the brand Clamelle, azithromycin will be supplied from pharmacies to over‐16s who have tested positive for infection but have no symptoms; their partners may also be treated. A urine testing kit will be marketed to pharmacists.Product newsSodium valproate (Epilim Chronosphere) is now available as modified‐release granules to be taken with food or a drink; 30 sachets, in five strengths from 50750mg, cost £30.Boehringer Ingelheim has introduced a higher strength of its telmisartan/hydrochlorothiazide combination (Micardis Plus) for hypertension; 80mg/25mg costs £14.18 for a month's supply. Copyright © 2008 Wiley Interface Ltd