Medication Errors Could Be Cut: Experts - Two reports show promise of computers, pharmacists for proper prescribing

Medication errors and adverse drug reactions cost lives and dollars each year in the United States, but two new reports suggest ways hospitals and pharmacists can work to reduce these mistakes.

Medication errors are one of the most common medical errors, affecting at least 1.5 million people every year and costing the health-care system between $77 billion and $177 billion annually, researchers point out in the April 27 issue of the Archives of Internal Medicine.

In the first report, researchers led by Dr. Jeffrey L. Schnipper, of Brigham and Women's Hospital and Harvard Medical School, used a computer system to keep track of the medications patients were taking when they were admitted to the hospital and the medications they were taking when they were discharged.

"It turns out that we commit about 1.5 errors per patient either for the admissions orders in the hospital or, much more commonly, in the discharge orders, which is kind of appalling," Schnipper said. "These are errors with potential for patient harm. There are about three times as many errors without potential for patient harm."

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It's the Cymbalta Stupid

Many are outraged that Eli Lilly gave nonprofits $3.9 million in grants last year for medical courses to "educate" doctors about the pain-and-fatigue ailment fibromyalgia--more than it spent for diabetes and Alzheimer's which people already know they have.

But finding new diseases to justify a drug's existence is the normal way pharma operates.

Especially Lilly who agreed to pay $1.42 billion for illegal marketing of its anti-psychotic Zyprexa last month--$615 million for criminally promoting it for dementia--another $62 million to 32 states for illegal pediatric marketing and agreed to resolve Medicaid fraud investigations into "rebates" at the same time. (And how was your year?)

And whose diabetes treatment Byetta is tanking since reports last summer of six deaths, at least two from pancreatitis.

But Lilly's fibromyalgia-fighting drug, Cymbalta (duloxetine)--its second best seller after Zyprexa--is anything but normal.

Starting with the death of 19-year-old Cymbalta test subject Traci Johnson in 2004--who hanged herself in the Lilly Clinic in Indianapolis and had no history of mental problems--it has been beset by reports of baffling, rapid, unprovoked, and out of character suicides and suicide attempts.

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High Level Of Adverse Drug Reactions In Hospitals Found

In a study of more than 3,000 patients, researchers at the University of Liverpool have found that one in seven admitted to hospital experience adverse drug reactions to medical treatment.

Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on ADRs that develop following hospital treatment is lacking. To further understanding of the clinical characteristics of ADRs, researchers at Liverpool assessed drug reactions of patients on 12 hospital wards over a six-month period.

Researchers found that 15% of patients admitted to hospital experienced one or more adverse reactions, which included constipation, confusion, renal problems, bleeding and infection with Clostridium difficle. Drugs most commonly associated with ADRs were anticoagulants, analgesics and diuretics.

The team also found that ADRs increased the length of a patient's hospital stay by an average of 0.25 days, and that those most susceptible were elderly patients on a number of different medications.

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Short-term use of antipsychotics in older adults with dementia linked to serious adverse events

Older adults with dementia who receive short-term courses of antipsychotic medications are more likely to be hospitalized or die than those who do not take the drugs, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Newer antipsychotic drugs (olanzapine, quetiapine fumarate and risperidone) have been on the market for more than a decade and are commonly used to treat the behavioral and psychological symptoms of dementia,” the authors write as background information in the article. “Antipsychotic drugs are often used for short periods to treat agitation in clinical practice. They are frequently prescribed around the time of nursing home admission.” About 17 percent of individuals admitted to nursing homes are starting on antipsychotic medication within 100 days, and 10 percent receive only a single prescription. Given the widespread use of short-term prescriptions, it is important to evaluate their safety, the authors note.

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Who Are We? Coming of Age on Antidepressants

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”

At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.

But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline.

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FDA looks at link between medications, depression

Federal regulators warn that an array of drugs could play a role in spurring thoughts of suicide or other psychiatric symptoms.

As symptoms of depression go, there is none much clearer than having thoughts of suicide.

But a spate of recent announcements from federal health officials suggests a surprising new interpretation of suicidal fantasies and the depression they are thought to signal: Sometimes, sadness, anxiety and self-destructive thoughts are not symptoms but side effects -- of medicine.

In this year alone, federal regulators have warned that a surprising array of drugs could play a role in spurring thoughts of self-destruction. Medicines that treat epilepsy, asthma and influenza are now under suspicion, as is one that helps smokers kick the tobacco habit.

The FDA stresses that it has established no direct causal link between these medications and suicidal thoughts in patients taking them. But in all the cases, regulators acknowledge they had one of two indicators of potential trouble.

In some cases, a review of a drug's early clinical trials turned up increased rates of suicidal thinking among subjects taking the medicine. In others, the tip-off came when the FDA observed an uptick of reports that patients taking a medication for some other condition developed symptoms of depression.

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Review of Adverse Effect Profile, Safety, and Dosing of Antidepressants

n 2002, 8.5% of the US population purchased at least one prescription antidepressant.1 Given this relatively high rate of antidepressant use, best practices should be followed in choosing the correct medication and dosing, to avoid adverse events or ineffective treatment. Two of the major classes of antidepressants that are more commonly prescribed are the selective serotonin reuptake inhibitors (SSRIs) and the tricyclic antidepressants (TCAs). The SSRIs are generally the antidepressants of first choice. They are relatively safe and effective. The Cochrane Collaboration reviewed 32 well-conducted trials and found SSRIs to be just as effective as TCAs with fewer adverse effects in the elderly population.2 In the inpatient population, TCAs appear to be slightly more effective than SSRIs, but TCAs were noted to have decreased tolerability.3 Given the popularity and tolerability of SSRIs, this review focuses mainly on this group of antidepressants and also touches on some of the newer unique antidepressants.

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Anti-depressants And Painkillers Combined Linked To Gastrointestinal Bleeding

New research shows that selective serotonin reuptake inhibitors (SSRIs), a group of drugs commonly used to treat depression, may double the risk of gastrointestinal bleeding, according to researchers from Wake Forest University School of Medicine and colleagues. When the drugs are taken with aspirin and other similar pain medications, the risk is more than 600 percent higher.

Painkillers such as ibuprofen are widely used by the public and can be purchased from supermarkets and pharmacies without prescription.

"Clinicians who prescribe these medications should be aware of the potential risk and may need to consider alternatives," said Sonal Singh, M.D., senior researcher and an assistant professor of internal medicine. "In addition, regulatory authorities should consider revising existing package inserts to highlight the magnitude of the risk."

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Genes Tied to Bad Reactions to Antidepressant Drug

Variations in two genes may increase the likelihood that a person will report suicidal thoughts after taking an antidepressant, researchers reported yesterday. The finding could help doctors develop tests to predict which patients will do well on such medications and which will react badly.

The authors of the study, which was released to reporters yesterday and will appear in The American Journal of Psychiatry on Monday, said that the findings were preliminary and would need to be verified by further testing.

The study focused on reactions to only one drug, Celexa from Forest Laboratories, and found no link between the gene variations and dangerous behavior like suicide attempts.

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Adverse drug reactions rise sharply, study says

The number nearly triples since the FDA began a new reporting system in 1998. The main culprits are painkillers.

The number of serious adverse events and deaths attributed to prescription medications has nearly tripled since the Food and Drug Administration initiated a system in 1998 to make it easier to report significant side effects, researchers said today.

Twenty percent of drugs accounted for 87.1% of adverse effects, and the biggest offenders were painkillers and drugs that modify the immune system to treat arthritis, according to the report in the Archives of Internal Medicine.

A quarter of the increase could be attributed to a boost in prescriptions and another 15% to the introduction of new biotechnology drugs since 1998, but the rest of the increase could not be explained, said drug safety expert Thomas J. Moore of the Institute for Safe Medication Practices in Huntingdon Valley, Pa.

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