Small Doses: News for Pharmacists

We know you can’t possibly keep up with all the news about pharmacy. So that’s why we’re bringing you these “Small Doses.” It's the news you need in a way that works for you.

This time, we're taking a look at supplements, the link between depression and drugs, the opioid crisis, and more. 

Click here to read the last Small Doses

Up next: Selenium, Vitamin E, and Dementia

Selenium and Vitamin E Supplements Don’t Help Prevent Dementia

People take many types of supplements in the hopes of preventing dementia in their later years, but it appears that the antioxidants selenium and vitamin E, either by themselves or combined, don’t help. A cohort study with more than 3700 men found no difference in the incidence of dementia between groups taking selenium alone, vitamin E alone, selenium and vitamin E combined, or a placebo. This study started in 2002 as a double-blind randomized clinical trial that was ancillary to a trial investigating the effects of the two supplements on prostate cancer and then was transformed in 2009 into a cohort study, called PREADViSE, that ran until 2015. It enrolled men over age 60 who were evaluated for dementia annually with memory screening done by telephone. The authors wrote, “To our knowledge, this is the first study to investigate the long-term association of antioxidant supplement use and dementia incidence among asymptomatic men.” The results were published online in the March 20, 2017, issue of JAMA Neurology.

Kryscio RJ, AGner EL, Caban-Holt A, et al: Association of Antioxidant Supplement Use and Dementia in the Prevention of Alzheimer’s Disease by Vitamin E and Selenium Trial (PREADViSE).JAMA Neurol. Published online March 20, 2017. doi:10.1001/jamaneurol.2016.5778

Drugs for Enlarged Prostate May Raise Risk of Depression and Self-Harm, But Not Suicide

There have been concerns that 5-alpha reductase inhibitors, used to treat benign prostate enlargement, increased a man’s risk of depression, self-harm, or suicide. Now, a large retrospective study has found that these drugs (including Avodart, Jalyn, Proscar, and Propecia) appear to increase the risk of depression and self-harm, but not the risk of suicide. The Canadian study linked data for 93,197 men 66 or older who had started on a 5-alpha reductase inhibitor between 2003 and 2013 and matched them with an equal number of men who did not take the drugs. Risk of self-harm was significantly increased during the first 18 months after the drug was started, but not thereafter. Depression risk was elevated during the first 18 months, and continued to be elevated, but to a lesser degree, for the remainder of follow-up. The study was published in JAMA Internal Medicine.

Welk B, McARthur E, Ordon M et al: Association of suicidality and depression with 5α-reductase inhibitors.JAMA Intern Med. Published online March 20, 2017. doi:10.1001/jamainternmed.2017.0089

Toddlers Are the Littlest Opioid Epidemic Victims

The number of children under age 5 who died after ingesting opioids rose by a factor of 10 between 2000 and 2015. Last year, four children died this way in Milwaukee County, WI, alone and another died there in January. Children may find a loose pill that was dropped accidentally or get their hands on an open pill vial. The Associated Press published a feature that looks at three cases where a young child died after swallowing opioids like methadone or Suboxone.

Ehlke G. Some of the youngest opioid victims are curious toddlers. Associated Press. March 23, 2017.

What Are the Best Drugs for Diabetic Neuropathy? A Review Narrows Down the Field.

Certain drugs appear to do better than others at treating pain and numbness due to diabetic peripheral neuropathy, according to a review of more than 100 published and unpublished studies. It found moderate evidence that duloxetine and venlafaxine are effective and weak evidence that pregabalin, oxcarbazepine, tricyclic antidepressants, and atypical opioids such as tramadol are more effective than placebo at reducing pain. Gabapentin was found to be no more effective than placebo. However, the study authors, led by Julie Waldfogel, PharmD, noted that few of the studies evaluated included information on whether any of these drugs had appositive effect on quality of life.

Waldfogel JM, Nesbit SA, Dy SM, et al.: Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurol. Published online before print March 24, 2017.