Common Prescription Medications Research Articles

Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines

BackgroundFalls are the leading cause of injury-related death among older Americans. While some research has found that insomnia heightens falls, health care resource utilization (HCRU) and costs, the impact of insomnia treatments on fall risk, mortality, HCRU and costs in the elderly population, which could be of substantial interest to payers, has not been fully elucidated. This study evaluated the risk of falls and related consequences among adults ≥ 65 years of age treated with common prescription medications for insomnia compared with non-sleep disordered controls.MethodsThis was a retrospective cohort analysis of deidentified Medicare claims from January 2011 through December 2017. Medicare beneficiaries treated for insomnia receiving zolpidem extended-release, zolpidem immediate-release, trazodone, or benzodiazepines were matched with non-sleep disordered controls. The main outcomes were falls, mortality, healthcare resource utilization (HCRU), and medical costs during the 12 months following the earliest fill date for the insomnia medication of interest. Generalized linear models controlled for several key covariates, including age, race, sex, geographic region and Charlson Comorbidity Index score.ResultsThe study included 1,699,913 Medicare beneficiaries (59.9% female, mean age 75 years). Relative to controls, adjusted analyses showed that beneficiaries receiving insomnia medication experienced over twice as many falls (odds ratio [OR] = 2.34, 95% CI: 2.31–2.36). In adjusted analyses, patients receiving benzodiazepines or trazodone had the greatest risk. Crude all-cause mortality rates were 15-times as high for the insomnia-treated as controls. Compared with controls, beneficiaries receiving insomnia treatment demonstrated higher estimated adjusted mean number of inpatient, outpatient, and emergency department visits and longer length of inpatient stay. All-cause total adjusted mean costs were higher among insomnia treated patients ($967 vs $454).ConclusionsIndividuals receiving insomnia treatment had an increased risk of falls and mortality and higher HCRU and costs compared with matched beneficiaries without sleep disorders. Trazodone and benzodiazepines were associated with the greatest risk of falls. This analysis suggests that significant risks are associated with common, older generation insomnia medication treatments in the elderly. Nonetheless, these results should be interpreted with caution as the use of these medications may be indicative of underlying morbidity with potential for residual confounding.

Zuogui Wan improves spermatogenesis of GC1-spg cells through modulating AR-related pathways.

Zuogui Wan (ZGW) is a common prescription medication used in traditional Chinese medicine (TCM) to significantly improve the sperm quality and treat male infertility. This study evaluated the repair effect of ZGW and Levocarnitine (LEV) on GC1-spg cell injury induced by Glucosides of Tripterygium WilforDII Hook (GTW). The results showed that the ultrastructure and apoptosis rate of GC1- spg cells in LEV and ZGW group were considerably better than GTW. The transcriptional and translational level of CYP1A1, CYP17A1, androgen receptor (AR), SRD5A2 and proliferating cell nuclear antigen (PCNA) in GC-1spg cells of the LEV group were considerably elevated than GTW group (p<0.05 or 0.01). Furthermore, the transcriptional and translational levels of CYP19A1, CYP17A1, AR, SRD5A2 and PCNA in GC-1spg cells in ZGW group were found to be considerably elevated than the LEV group (p<0.05 or 0.01). The findings indicate that ZGW and LEV could increase the expression of PCNA, CYP17A1, CYP19A1, SRD5A2 and AR at transcriptional and translational levels, inhibit GC-1spg cell apoptosis and promoting cell proliferation, and the effect of ZGW was found to be significantly better than that of LEV.

Impact of Concomitant Medication Use and Immune-Related Adverse Events on Response to Immune Checkpoint Inhibitors

Aim: Patients receiving checkpoint inhibitors (CPI) are frequently on other medications for co-morbidities. We explored the impact of concomitant medication use on outcomes. Materials& methods:210metastatic cancer patients on CPI were identified and association between concomitant medication use and immune-related adverse events with clinical outcomes was determined. Results: Aspirin, metformin, β-blockers and statins were not shown to have any statistically significant difference on clinical benefit. 26.3% patients with clinical benefit developed rash versus 11.8% without clinical benefit (p<0.05) on multivariate analysis. Conclusion: Use of common prescription and nonprescription medications in patients with multiple co-morbidities appears safe and does not have an adverse effect on CPI efficacy. The presence of rash predicted for a better response.

Prescription medication cost, insurance coverage, and cost-related nonadherence among people with spinal cord injury in Canada.

Observational cross-sectional study. To describe the most common prescription medications used and the extent of out-of-pocket cost, insurance coverage, and cost-related nonadherence (CRNA) for those medications by people with spinal cord injury (SCI) in Canada. Community in Canada. It was an observational study wherein data were collected through a cross-sectional online survey from individuals living with an SCI in Canada. We used descriptive statistics to describe the extent of drug cost, insurance coverage and CRNA among study sample, and analytical statistics to find association of CRNA with sociodemographic, injury-related and medication-related characteristics of the sample. Individuals with an SCI (n = 160) used an average of five medications and spent a median of $49 (interquartile range: $234.75) per month on their medications. More than 90% of participants had some form of drug insurance, though 37% reported CRNA. The most common medications that were forgone due to cost included opioids, antidepressants, and drugs for genitourinary and muscular spasms. Individuals with paraplegia and nontraumatic SCI had higher drug costs, though injury-related characteristics did not influence CRNA. Sex, monthly drug expenditure, and monthly additional healthcare costs were significantly associated with CRNA. People with SCIs are at risk of experiencing CRNA to their prescription medications despite having insurance coverage. Decision makers for the national pharmacare in Canada should account for their concerns judiciously.

Medical and Supplement Use and Peripheral Neuropathies

Peripheral neuropathy often causes severe pain requiring an individualized approach to treatment. Guidelines emphasize stepwise treatment with a focus on both pharmacological and nonpharmacological therapy management. This retrospective, descriptive, cross-sectional study analyzed current prescription and over-the-counter medication and supplement use trends in 45 symptomatic patients attending a community-based, free peripheral neuropathy educational clinic. Before each visit, patients completed a self-reported questionnaire that consisted of demographic data as well as current prescription and over-the-counter medications and supplements. The most common prescription medications included anticonvulsants, antidepressants, and opioids, generally consistent with guidelines for the treatment of neuropathic pain.

Systemic Health Characteristics and Self-Reported Xerostomia among Nursing Facility Residents in Iowa-US and Sao Paulo-Brazil

Objective: To describe and compare potential differences in systemic health characteristics and xerostomia among residents in American and Brazilian nursing facilities (NF). Material and Methods: This secondary analysis used data from a study in NF located in Iowa-USA (n=81) and Sao Paulo (SP)-Brazil (n=119). Recorded data included demographics, medications, comorbid conditions, and self-reported xerostomia. Results The Iowa group mean age was 82.1 years (±12.9), 60.5% were females, and 100% were white, whereas the SP group mean age was 76.4 years (±8.7), 47.9% females, most participants identified as either white (42.0%) or as more than one race (45.4%). The median number of comorbid conditions and medications in the Iowa were 9 and 12, respectively, as compared to 2 and 6 in SP. Most common comorbidities in Iowa were hypertension, dementia (including Alzheimer), and depression. In SP, they were hypertension, unspecified diabetes mellitus (including type 2), and Parkinson. Most common prescription medications in Iowa were acetaminophen, acetylsalicylic acid, and magnesium hydroxide, while in SP, they were omeprazole, acetylsalicylic acid, and losartan. Xerostomia was reported by 32.1% (Iowa) and 59.7% (SP) of the participants. There was no association between age and dry mouth sensation in either Iowa (p=0.480) or SP (p=0.130) samples. However, there was an association between total medications and dry mouth sensation in Iowa (p=0.040), but not in SP (p=0.075) Conclusions: Iowans presented with higher numbers of comorbidities and prescription medications, however xerostomia was reported in a greater percentage in SP. Xerostomia was associated to higher number of medications in Iowa, but not in SP. KeywordsXerostomia; Aged; frail elderly; Nursing homes.

Gut microbiota associations with common diseases and prescription medications in a population-based cohort

The human gut microbiome has been associated with many health factors but variability between studies limits exploration of effects between them. Gut microbiota profiles are available for >2700 members of the deeply phenotyped TwinsUK cohort, providing a uniform platform for such comparisons. Here, we present gut microbiota association analyses for 38 common diseases and 51 medications within the cohort. We describe several novel associations, highlight associations common across multiple diseases, and determine which diseases and medications have the greatest association with the gut microbiota. These results provide a reference for future studies of the gut microbiome and its role in human health.

Does common prescription medication affect the rate of orthodontic tooth movement? A systematic review.

As the taking of any medication may theoretically affect the complex pathways responsible for periodontal tissue homeostasis and the events leading to orthodontic tooth movement, it is considered important for the orthodontist to be able to identify prospective patients' history and patterns of pharmaceutical consumption. To systematically investigate and appraise the quality of the available evidence regarding the effect of commonly prescribed medications on the rate of orthodontic tooth movement. Search without restrictions in eight databases and hand searching until June 2017. Controlled studies investigating the effect of commonly prescribed medications with emphasis on the rate of orthodontic tooth movement. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Twenty-seven animal studies, involving various pharmacologic and orthodontic interventions, were finally identified. Most studies were assessed to be at unclear or high risk of bias. The rate of orthodontic tooth movement was shown to increase after the administration of diazepam, Vitamin C and pantoprazole, while simvastatin, atorvastatin, calcium compounds, strontium ranelate, propranolol, losartan, famotidine, cetirizine, and metformin decreased the rate of orthodontic tooth movement. No interference with the rate of orthodontic tooth movement was reported for phenytoin, phenobarbital and zinc compounds, whereas, inconsistent or conflicting effects were noted after the administration of L-thyroxine, lithium compounds, fluoxetine and insulin. The quality of the available evidence was considered at best as low. Commonly prescribed medications may exhibit variable effects on the rate of orthodontic tooth movement. Although the quality of evidence was considered at best as low, raising reservations about the strength of the relevant recommendations, the clinician should be capable of identifying patients taking medications and should take into consideration the possible implications related to the proposed treatment. PROSPERO (CRD42015029130).

Drug-Drug Interaction Assessment and Identification in the Primary Care Setting.

BackgroundDrug-drug interactions (DDIs) are ubiquitous, harmful and a leading cause of morbidity and mortality. With an aging population, growth in polypharmacy, widespread use of supplements, and the rising opioid abuse epidemic, primary care physicians (PCPs) are increasingly challenged with identifying and preventing DDIs. We set out to evaluate current clinical practices related to identifying and treating DDIs and to determine if opportunities to increase prevention of DDIs and their adverse events could be identified.MethodsIn a nationally representative sample of 330 board-certified family and internal medicine practitioners, we evaluated whether PCPs assessed DDIs in the care they provided for three simulated patients. The patients were taking common prescription medications (e.g. opioids and psychiatric medications) along with other common ingestants (e.g. supplements and food) and presented with symptoms of DDIs. Physicians were scored on their ability to inquire about the patient’s medications, investigate possible DDIs, evaluate the patient, and provide treatment recommendations. We scored the physicians’ care recommendations against evidence-based criteria, including overall care quality and treatment for DDIs.ResultsAverage overall quality of care score was 50.5% ± 12.0%. Despite >99% self-reported use of medication reconciliation practices and tools, physicians identified DDIs in only 15.3% of patients, with 15.5% ± 20.3% of DDI-specific treatment by the physicians.ConclusionsPCPs in this study did not recognize or adequately treat DDIs. Better methods are needed to screen for DDIs in the primary care setting.

Rare Cardiac Manifestation of a Commonly Prescribed Drug: Takotsubo Cardiomyopathy Caused by Allopurinol Induced Dress Syndrome

It presents a case of 42-year-old male with history of chronic kidney disease stage with rash, itching and swelling. Two weeks before he was started on allopurinol for hyperuricemia. Exam showed swelling of face, extremities with diffuse papular rash. Temperature 99.3, BP 122/93, RR 18. Blood work showed worsening renal function (Cr 3.10), transaminitis (LDH 184, AST 104, ALT 136) and eosinophilia of 13.6%. RegiSCAR score of 6 was highly suggestive of Dress Syndrome. Patient's allopurinol was discontinued. Patient was started on steroids and showed improvement. Patient returned three weeks later with chest pain and shortness of breath. BP 110/68, Pulse rate 132, respiratory rate 30 breaths/min, Sat O2 87%.CK-MB 30 and troponin 10. Eosinophil count 19%. EKG showed sinus tachycardia and diffuse ST elevation. Emergent cardiac catheterization showed no coronary artery disease, severe LV systolic dysfunction with apical dilation. Ejection fraction was 20% (EF of 55%-60% baseline). Findings were consistent with Takotsubo Cardiomyopathy (TS). He was continued on steroids and lasix. Skin biopsy showed superficial perivascular dermatitis. Subendocardial biopsy showed mild perivascular and subendocardial infiltrates not suggestive of active eosinophilic myocarditis. Patient condition stabilized, and EF improved to 45%-50%. He was discharged on prednisone taper. Discussion: DRESS syndrome is rare, potentially life-threatening hypersensitivity reaction. Early recognition is important as it has associated mortality of 10%. European Registry (RegiSCAR) is the most commonly used diagnostic criteria. Drug induced Takotsubo cardiomyopathy is mostly associated with medication causing direct or indirect catecholamine stimulation. Although a common association with Dress Syndrome, allopurinol induced takotsubo cardiomyopathy is extremely rare. To our knowledge only one other case has reported. We aim to highlight the importance of clinical suspicion for takotsubo cardiomyopathy in patients with new onset heart failure treated with allopurinol that remains a common prescription medication.

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

Background . Failure to exclusively breastfeed is often caused by a perception of insufficient breastmilk supply. Galactogogues are frequently prescribed in these circumstances, but this is supported by sparse scientific data with safety concerns for both mother and infant. The exact extent of galactogogue use in South Africa (SA) is not well known. Objectives . To assess breastfeeding behaviour, galactogogue use and perceived galactogogue side-effects among patients attending International Board Certified Lactation Consultant (IBCLC) private practices. Methods . We administered a self-developed, expert-reviewed questionnaire in five IBCLC private practices within the Cape Town Metropole, SA. All patients attending the practices during an 8-week period were invited to participate. Results . Data from 104 participants were included in the study. An exclusive breastfeeding rate of slightly more than 50%, associated with greater parity ( p =0.029), was found. Perceived lack of breastmilk predicted galactogogue use ( p =0.013). There was a high prevalence of galactogogue use (54%), with 80% of these participants using non-prescription medication. Sulpiride was the most common prescription medication used. Increased milk production was reported by 41% ( n =23) of galactogogue users, while 30% ( n =17) reported no effect. Most reported side-effects were minor. Conclusions . Prevalence of galactogogue use exceeded other published data. Sulpiride was most frequently prescribed, despite not being recommended during breastfeeding. A large group of participants reported poor efficacy. The effect of vaginal delivery and immediate skin-to-skin contact after delivery on milk production might be smaller than previously reported in mothers who are personally motivated to breastfeed. Healthcare practitioners should acknowledge breastfeeding mothers’ concerns regarding insufficient milk supply and emphasise correct breastfeeding technique

Evaluating the Completness of Physician Billing Claims: A Proof-of-Concept Study

ABSTRACTObjectivesAn increasing number of physicians are remunerated by alternative forms of payment, instead of conventional fee-for-service (FFS) payments. Changes in physician remuneration methods can to influence the completeness of physician billing claims databases, because physicians on alternative payments may not consistently complete billing records. However, there is no established technique to estimate the magnitude of data loss. This proof-of-concept study estimated completeness of physician claims by comparing them with prescription drug records. We applied the method to estimate completeness of non-fee-for-service (NFFS) and FFS physician claims data over time in Manitoba, Canada.&#x0D; ApproachOur method uses information on the date of patient initiation of a new prescription medication, payment method of the prescribing physician, and presence/absence of a physician billing claim prior to the medication initiation date. A billing claim within 7 days of the medication initiation date was defined as a captured claim; if there was no claim in this observation window, it was classified as missed. Our method was applied to annual patient cohorts who initiated a common prescription medication (i.e., anti-hypertensives) between fiscal years 1998/99 and 2012/13. A sensitivity analysis used a 21-day observation window to identify captured/missing claims. Multivariable hierarchical logistic regression models tested patient and prescriber characteristics associated with missing claims.&#x0D; ResultsThe cohort consisted of 274, 462 individuals with a new anti-hypertensive prescription medication. A total of 9.2% of the cohort had a NFFS prescribing physician in 1998/99; this increased to 20.2% in 2012/13 (linear trend p-value &lt; .0001). The percentage of NFFS prescribers almost doubled, from 10.0% to 17.8%. The percentage of the annual cohorts with a FFS prescribing physician and a missing claim remained close to 13.0%. However, the percentage of the annual cohorts with a NFFS prescribing physician and a missing claim increased from 15.6% to 23.3% (linear trend p-value &lt; .0001), and was always higher than the FFS percentage. Patient age, sex, and comorbidity and physician specialty and practice location were associated with the odds of a missing claim.&#x0D; ConclusionThe percentage of missing claims was higher for patients with NFFS than FFS prescribing physicians, demonstrating the impact of physician remuneration on database completeness. The trend of greater data loss in later than earlier years suggests that completeness of physician billing claims data may be decreasing. Our method can be applied across jurisdictions to compare the impact of physician payment methods on data quality.

Evaluating increased resource use in fibromyalgia using electronic health records.

ObjectiveThe management of fibromyalgia (FM), a chronic musculoskeletal disease, remains challenging, and patients with FM are often characterized by high health care resource utilization. This study sought to explore potential drivers of all-cause health care resource utilization and other factors associated with high resource use, using a large electronic health records (EHR) database to explore data from patients diagnosed with FM.MethodsThis was a retrospective analysis of de-identified EHR data from the Humedica database. Adults (≥18 years) with FM were identified based on ≥2 International Classification of Diseases, Ninth Revision codes for FM (729.1) ≥30 days apart between January 1, 2008 and December 31, 2012 and were required to have evidence of ≥12 months continuous care pre- and post-index; first FM diagnosis was the index event; 12-month pre- and post-index reporting periods. Multivariable analysis evaluated relationships between variables and resource utilization.ResultsPatients were predominantly female (81.4%), Caucasian (87.7%), with a mean (standard deviation) age of 54.4 (14.8) years. The highest health care resource utilization was observed for the categories of “medication orders” and “physician office visits,” with 12-month post-index means of 21.2 (21.5) drug orders/patient and 15.1 (18.1) office visits/patient; the latter accounted for 73.3% of all health care visits. Opioids were the most common prescription medication, 44.3% of all patients. The chance of high resource use was significantly increased (P<0.001) 26% among African-Americans vs Caucasians and for patients with specific comorbid conditions ranging from 6% (musculoskeletal pain or depression/bipolar disorder) to 21% (congestive heart failure). Factors significantly associated with increased medications ordered included being female (P<0.001) and specific comorbid conditions (P<0.05).ConclusionPhysician office visits and pharmacotherapy orders were key drivers of all-cause health care utilization, with demographic factors, opioid use, and specific comorbidities associated with resource intensity. Health systems and providers may find their EHRs to be a useful tool for identifying and managing resource-intensive FM patients.

Psychiatric Prescribers' Experiences With Doctor Shoppers.

Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.

Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership

ObjectivesThe Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National...

Self-medication in Central Saudi Arabia. Community pharmacy consumers' perspectives.

Objectives:To determine the prevalence of self-medication and assess the knowledge, attitudes, and perception of consumers toward self-medication.Methods:This cross-sectional survey was conducted over 4 weeks in May 2011 in Riyadh city, Kingdom of Saudi Arabia. Community pharmacies within 5 areas of the city (North, South, West, East, and Middle) were randomly selected for the study. All consumers were approached to participate in the study, with the exception of those buying cosmetic and medicinal equipments. A validated self-administered questionnaire was used to collect the data.Results:A total of 538 out of 707 consumers attending community pharmacies in Riyadh city, agreed to participate in the study. Most responders were male (73%), 23-33 years old (35%), and college graduates (42%). A total of 285 medications were bought without a prescription. Of these, 149 (49%) medications should be dispensed by prescription only, and 155 (51%) were over the counter medications. The most common prescription medications dispensed without prescriptions were antibiotics (22%) and analgesics/antipyretics (19%). The most common reasons for buying medications without a prescription were that the symptoms were too minor to visit a doctor (54%), time saving (40%), and minor illnesses for which the participants knew the required treatment (40%). Overall, most participants had poor knowledge, and negative perceptions regarding self-medication. More than 68% of participants did not know whether the medicine they bought is a prescription-only or over the counter medication.Conclusion:Irresponsible self-medication is common in Saudi Arabia. Future studies should focus on improving the consumers’ awareness of self-medication and the proper use of medications.

Drugs That Negatively Affect Sleep

Getting adequate sleep is a healthy lifestyle activity that is important for the body to function optimally both physically and mentally. Unfortunately, 70 million Americans suffer from chronic sleep loss or sleep disorders. Secondary causes of sleep disorders are often overlooked and can occur from the consumption of social or medicinal drugs. Common social drugs that can disrupt sleep include alcohol, caffeine, and nicotine. Certain medications can also have side-effects that can induce sleep disruptions. This article briefly reviews common social drugs and prescription medications that can negatively impact sleep.

Common prescription medication use and erectile dysfunction: results from the Boston Area Community Health (BACH) survey

To investigate the association of erectile dysfunction (ED) with commonly used medications including antihypertensive treatment (AHT), psychoactive medication and pain and anti-inflammatory medication. The Boston Area Community Health (BACH) survey used a multistage stratified design to recruit a random sample of 2301 men aged 30-79 years. ED was assessed using the five-item International Index of Erectile Function (IIEF-5). Prescription medications, captured using a combination of drug inventory and self-report with a prompt by indication, included in this analysis comprised AHT, psychoactive medication, and pain and anti-inflammatory medication. Logistic regression was used to estimate the odds ratios (ORs) of the association of medication use with ED and to adjust for potential confounders including age, comorbid conditions and sociodemographic and lifestyle factors. Multivariable analyses showed benzodiazepines (adjusted OR = 2.34, 95% confidence interval [CI]: 1.03, 5.31) and tricyclic antidepressants (adjusted OR = 3.35, 95% CI: 1.09, 10.27) were associated with ED, while no association was observed for serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and atypical antipsychotics. The use of AHT, whether in monotherapy or in conjunction with other AHTs, and pain or anti-inflammatory medications were not associated with ED after accounting for confounding factors. Results of the BACH survey suggest adverse effects of some psychoactive medications (benzodiazepines and tricyclic antidepressants). No evidence of an association of AHT or pain and anti-inflammatory medication with ED was observed.

Pharmacokinetic evaluation of hydrocodone/acetaminophen for pain management

Hydrocodone/acetaminophen is not only the most commonly prescribed opioid in the United States but also the most common prescription medication written in America. Although original and early trials confirmed its ability to manage acute pain from surgery and musculoskeletal injury, it is perhaps more widely used today in the management of chronic pain. However, the opioid product was introduced for the management of moderate to moderately severe pain. Because it has been greatly abused as a prescription opioid medication, physicians need to be aware of the current knowledge regarding this analgesic drug. This review summarizes the current knowledge of the pharmacokinetics, pharmacodynamics, and metabolism of hydrocodone. Recent information regarding the possibility of hydrocodone as a prodrug for hydromorphone is discussed. The available clinical trials for the use of hydrocodone in the management of acute, chronic, and cancer pain are presented.

Abstract 860: Hypertension, diuretics, and antihypertensives in relation to bladder cancer

Abstract Background: The role of hypertension and/or antihypertensive medication use on bladder cancer risk is inconclusive. Given the high prevalence of hypertension in the United States, in the present study we investigated the relation between hypertension, antihypertensive drugs, and bladder cancer risk using a population-based case-control study conducted in Los Angeles County, California. Methods: A population-based case-control study of bladder cancer was conducted in Los Angeles County from 1987-1999 and a total of 1586 age-, gender-, race- matched cases and neighborhood controls were included in the analyses. Participants were asked if they were told by a doctor that they had hypertension. They were also asked if they had taken any of the 21 brand names of diuretics and antihypertensive drugs listed in the questionnaire, which represented all the common prescription medications in these respective categories marketed in the US since the 1950s. Regular use was defined as taking a listed brand name drug two or more times a week for one month or longer. We asked regular users the ages at first and last use, duration of use, usual frequency and dosage of use, and the primary reason for such use. Results: A history of hypertension was not related to bladder cancer; however, among hypertensive individuals, there was a significant difference in bladder cancer risk related to the use of diuretics or antihypertensive drugs (P for heterogeneity =0.003). Compared with individuals without hypertension, hypertensive individuals who regularly used diuretics/antihypertensives had a similar risk (odds ratio - OR, 1.05; 95% confidence interval − 95%CI, 0.86-1.29), while untreated hypertensive subjects had a 36% reduction in risk (OR, 0.64; 95% CI, 0.47-0.87). A greater reduction in bladder cancer risk was observed among current smokers (OR, 0.45; 95% CI, 0.28-0.72) and carriers of GSTM1 null (homozygous absence) genotypes (OR, 0.29; 95% CI, 0.16-0.54). Similarly, among smokers with GSTM1 null genotype, levels of 4-aminobiphenyl-hemoglobin adducts were significantly lower among untreated hypertensive individuals (45.7 pg/g Hb) compared to individuals without hypertension (79.8 pg/g Hb) (P = 0.009). Conclusion: Our results suggest that untreated hypertension is associated with a reduced risk of bladder cancer, a finding that was partially supported by our biomarker data. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 860.