Bulletin Today
New research published recently in the Journal of the American Heart Association found that some heart medications, including statins, aspirin, and blood pressure medications, were prescribed less frequently to women than to men.
The systematic review included a total of 43 international studies with data on primary care prescriptions among more than 2.2 million patients. The research team looked specifically at studies on statin prescriptions, aspirin, and blood pressure lowering medications, such as ACE inhibitors and diuretics. Women comprised 28% of the study participants with an average age of 51 to 76 years. All patients were at risk for heart attacks.
Previous research has indicated that women are prescribed heart medications less frequently than men in the hospital setting. Researchers wanted to know if women who were at high risk or had cardiovascular disease were less likely to receive recommended heart medications in the primary care setting.
According to the findings, women received 19% fewer aspirin prescriptions than men, 10% fewer statin prescriptions than men, and 15% fewer ACE-inhibitor prescriptions than men. However, women were 27% more likely than men to be prescribed diuretics, according to the findings.
USPSTF recommends HCV screening for nearly all adults
The U.S. Preventive Services Task Force (USPSTF) now recommends that all adults starting at age 18 be screened for hepatitis C virus (HCV) infection, the most common chronic blood-borne pathogen in the United States and a leading cause of complications from chronic liver disease.
According to the JAMA Network article where the recommendation was published, “cases of acute HCV infection have increased approximately 3.8-fold over the last decade because of increasing injection drug use and improved surveillance.”
The updated recommendation replaces what USPSTF said in 2013 about HCV infection screening. In the past, they only recommended HCV infection screening for those who were at high risk for infection, and they recommended a one-time screening in adults born between 1945 and 1965.
The updated recommendation applies to all asymptomatic adults aged 18 to 79 years without known liver disease. USPSTF also recommends that all pregnant women be screened for HCV during each pregnancy.
Antibiotics overprescribed at the start of COVID-19 pandemic
In March and April, physicians turned to broad-spectrum antibiotics to treat patients flooding emergency departments who were exhibiting symptoms of COVID-19. Such shot-in-the-dark medications are often used against bacterial infections that cannot be immediately identified.
According to a June 4 New York Times article, Teena Chopra, MD, the director of epidemiology and antibiotic stewardship at Detroit Medical Center, said roughly more than 80% of arriving patients were given antimicrobial drugs. Chopra and other physicians across the country who liberally dispensed antibiotics in the early weeks of the pandemic said they soon realized their mistake. “Many physicians were inappropriately giving antibiotics because, honestly, they had limited choices,” said Chopra in the New York Times article.
Now that the initial flood of patients in hard-hit cities has subsided, physicians across the United States are seeking to draw lessons from their overuse of antibiotics, a practice that can spur resistance to the lifesaving drugs. Widespread fears that COVID-19 patients were especially susceptible to drug-resistant infections appear to have been misguided.
FDA says certain epinephrine auto-injectors could have a malfunction
FDA is asking patients, caregivers, and health professionals to immediately check certain lots of Amneal and Impax epinephrine auto-injector 0.3 mg to make sure the yellow “stop collar” in the device is present.
Impax Laboratories, a subsidiary of Amneal Pharmaceuticals, the manufacturer of the epinephrine auto-injector, described in recent letters to consumers and health professionals how some lots of these devices may not have the yellow “stop collar” feature. If that component is missing, the device could potentially deliver a double dose of epinephrine to a patient.
For those who received an Amneal or Impax epinephrine auto-injector after December 20, 2018, the visual inspection of the device should include: removing the auto-injector from the carrying case; placing the auto-injector on a flat surface; locating the edge of the label that states, “Peel here for further instructions,” lifting up the label edge until the clear part of the auto-injector is visible; and then looking for the yellow “stop collar” inside the clear portion of the device.
If the yellow “stop collar” is not visible there, gently rotate the blue sheath remover, without pulling or removing it, to see if the yellow “stop collar” comes into view. If the yellow “stop collar” is present, the product is safe to use and no further action is needed. Re-wrap the label to its original position and place the auto-injector back in the carrying case.
FDA said it “is notifying patients and caregivers that epinephrine auto-injectors are not being recalled. We urge patients and caregivers to use the epinephrine auto-injector they have on hand and be aware of the potential issues outlined in the statement above.”
FDA asking companies to recall contaminated metformin
FDA reported in late May that agency laboratory testing has identified levels of the nitrosamine impurity N-Nitrosodimethylamine (NDMA) above the agency’s acceptable intake limit in several lots of extended-release (ER) metformin. At press time, five companies have voluntarily recalled ER formulations of metformin after FDA recommended they do so. Those companies include: Apotex (all lots), Amneal (all lots), Marksans (branded as Time-Cap—one lot), Lupin (one lot), and Teva (branded as Actavis—14 lots). “Assessments are underway to determine whether metformin ER recalls will result in shortages and the agency will work closely with manufacturers to prevent or reduce any impact of shortages,” FDA said in a statement. According to the agency, patients should continue taking metformin tablets until they talk to their health care provider, who can prescribe a replacement.
FDA testing has not found NDMA in immediate-release metformin tablets. The agency is requesting that all manufacturers of metformin-containing ER products test each batch before it is released to the U.S. market.
FDA announced in late 2019 that it had become aware of NDMA in some metformin products in other countries, and it started testing to determine whether the metformin in the United States was at risk. In February 2020, the agency said it had found very low levels of NDMA in some samples, but no FDA-tested sample of metformin exceeded the acceptable intake limit for NDMA at that time. FDA recently became aware of reports of higher NDMA levels in some ER formulations of metformin through a citizen petition filed by a private laboratory, and its testing of those same metformin lots also identified NDMA above the acceptable intake limit.