Drug-drug interactions involving antidepressants: focus on desvenlafaxine.

Psychiatric and physical conditions often coexist, and there is robust evidence that associates the frequency of depression with single and multiple physical conditions. More than half of patients with depression may have at least one chronic physical condition. Therefore, antidepressants are often used in cotherapy with other medications for the management of both psychiatric and chronic physical illnesses. The risk of drug-drug interactions (DDIs) is augmented by complex polypharmacy regimens and extended periods of treatment required, of which possible outcomes range from tolerability issues to lack of efficacy and serious adverse events. Optimal patient outcomes may be achieved through drug selection with minimal potential for DDIs. Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of adults with major depressive disorder. Pharmacokinetic studies of desvenlafaxine have shown a simple metabolic profile unique among antidepressants. This review examines the DDI profiles of antidepressants, particularly desvenlafaxine, in relation to drugs of different therapeutic areas. The summary and comparison of information available is meant to help clinicians in making informed decisions when using desvenlafaxine in patients with depression and comorbid chronic conditions.

Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: risks versus benefits.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often coadministered with proton-pump inhibitors (PPIs) to reduce NSAID-induced gastrointestinal (GI) adverse events. This coadministration is generally regarded as safe, and is included in many of the guidelines on NSAID prescription. However, recent evidence indicates that the GI risks associated with NSAIDs can be potentiated when they are combined with PPIs. This review discusses the GI effects and complications of NSAIDs and how PPIs may potentiate these effects, options for prevention of GI side effects, and appropriate use of PPIs in combination with NSAIDs.

Comparing the Safety and Efficacy of Celecoxib for the Treatment of Osteoarthritis in Asian and non-Asian Populations: An Analysis of Data from Two Randomized, Double-blind, Placebo-controlled, Active-comparator Trials.

INTRODUCTION: Celecoxib is an effective treatment for pain associated with osteoarthritis. There are differences in patient demographics among ethnic groups, with Asian populations typically smaller in body size. As a consequence, there may be a perception that celecoxib is less effective, or has poorer tolerability in Asian patients. METHODS: This analysis compares data from two multicenter, randomized, double-blind, placebo-controlled, active-comparator trials of celecoxib for the treatment of osteoarthritis of the knee: one study in Asian patients and the other in a mixed population comprised mostly of non-Asian patients (from which Asian patients were excluded for this analysis). Each trial was of similar design, with patients randomized 2:2:1 to 6 weeks treatment with celecoxib 200 mg once daily, active comparator (naproxen 500 mg twice daily or ibuprofen 800 mg three times daily), or placebo. The primary efficacy endpoint in each trial was the change from baseline to week 6 in the Patient's Assessment of Arthritis Pain, as measured on a visual analog scale. RESULTS: In total, 329 patients were included in the efficacy analysis, 179 in the Asian study and 150 in the non-Asian study. The Asian population was significantly older and smaller in body size (P < 0.0001). There was no significant difference between the Asian and non-Asian populations in change in pain score (95% confidence interval) at study endpoint with celecoxib [-1.1 (-7.7, 5.5); P = 0.7400] or placebo [-5.2 (-14.8, 4.4); P = 0.2870]. There were also no notable differences in safety outcomes between populations. CONCLUSIONS: Due to the smaller size of some Asian patients with OA, physicians may be tempted to decrease the dose of celecoxib below the therapeutic range recognized by regulatory authorities; these data suggest that dose changes are not necessary. FUNDING: Pfizer Inc.

Health Inequalities in Diabetes Mellitus and Hypertension: A Parish Level Study in the Northern Region of Portugal.

INTRODUCTION: Diabetes and hypertension are highly prevalent conditions in Portugal. Little is known about the geographical and social patterning of these diseases, which precludes the design of targeted health policies. This study aimed to measure the geographical and socioeconomic distribution of type 2 diabetes and hypertension prevalence in the population resident in the Northern region of Portugal, for the year 2013. MATERIAL AND METHODS: An ecological correlation study analyzed the 2,028 parishes of the region. Prevalence data were obtained from the Regional Health Administration information system. Socioeconomic data were also obtained from this administrative database and from the 2011 national census. The association between each socioeconomic indicator and age-standardized prevalence was measured using the difference in prevalence, population attributable risk, relative inequality index, and regression coefficient. RESULTS: The prevalence of type 2 diabetes and hypertension was 6.16% and 19.35%, respectively, and varied across parishes. These prevalences were significantly associated with low educational level, low tertiary sector weight, unemployment, and low-income rate (with prevalence differences between the most and least advantaged deciles up to 1.3% and 5.3%, respectively). Socioeconomic factors accounted for up to 20% of prevalence. DISCUSSION: This study design did not allow us to evaluate causality and it may underestimate these diseases prevalence or its association with socioeconomic factors, but its results are in line with the evidence from other countries. CONCLUSION: These results emphasize the socioeconomic and geographical patterning of major diseases associated with a high mortality, and the need of health policies targeting the most deprived parishes.

Introdução: A diabetes mellitus e a hipertensão arterial são problemas de saúde de elevada prevalência em Portugal. A sua distribuição geográfica e social é pouco conhecida, comprometendo o desenho e implementação de políticas de saúde. Assim, este estudo teve como objetivo avaliar a existência das desigualdades socioeconómicas na prevalência de diabetes mellitus tipo 2 e hipertensão arterial, na população residente na região Norte de Portugal, no ano de 2013. Material e Métodos: Foi realizado um estudo ecológico que analisou as 2 028 freguesias da região Norte. Os dados foram obtidos através do Sistema de Informação das Administrações Regionais de Saúde e do Censos 2011. A associação entre indicadores socioeconómicos e prevalência destas doenças foi medida pela diferença de prevalências, risco atribuível populacional, índice relativo de desigualdades e coeficiente de regressão. Resultados: A prevalência de diabetes mellitus tipo 2 e hipertensão arterial foi de 6,16% e de 19,35%, respetivamente, e variou entre freguesias. A prevalência de ambas as doenças associou-se significativamente com o baixo nível educacional, baixa atividade no sector terciário, desemprego e baixo rendimento (diferença de prevalências entre decis opostos até 1,3% e 5,3%). Os determinantes socioeconómicos foram responsáveis até 20% da prevalência na população. Discussão: Este tipo de estudo não permitiu a análise de causalidade e poderá ter subestimado as desigualdades socioeconómicas. Contudo, os resultados obtidos alinham-se com a evidência científica internacional. Conclusão: Estes resultados demonstram a existência de uma distribuição socioeconómica e geográfica heterogénea e a necessidade de criação de políticas de saúde que atuem nas freguesias menos favorecidas.