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Freppel R, Gaboriau L, Richardson M, Ould Y, Domanski O, Pinçon C, Ghesquière L, Gautier S. Beta-blockers and breastfeeding: a real-life prospective study. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03753-y. [PMID: 39259357 DOI: 10.1007/s00228-024-03753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE At Lille University Hospital, a pregnancy heart team including cardiologists, obstetricians, pediatricians, anesthetists, geneticists, and pharmacologists discusses about treatment compatibility taken during breastfeeding in pregnant women (or those wishing to be pregnant) with complex cardiovascular pathologies. Beta-blockers are among the drug most often used in these patients, and data are missing or suggest a risk to the breastfed child. The aim of this study was to evaluate the proportion of women treated with beta-blockers, identified during the multidisciplinary meeting, who breastfed and to monitor adverse effects (AEs) in newborns. METHODS A prospective descriptive study was conducted from 1 December 2017 to 1 December 2021. All pregnant patients followed up by the pregnancy heart team in Lille University Hospital, treated with beta-blockers and who gave birth, were contacted as part of the pharmacovigilance follow-up. RESULTS The proportion of women treated with beta-blockers intending to breastfeed was 69.8%. Among the 53 women interviewed, 49% did not breastfeed, including 10 because of the theoretical incompatibility of their beta-blocker with breastfeeding. Among the 27 women who breastfed, 30% breastfed while treated with a theoretically incompatible beta-blocker; 56% was changed from their initial beta-blocker to allow safe breastfeeding. No serious AE was observed. CONCLUSION To our knowledge, our study is the largest series of patients treated with beta-blockers during breastfeeding. Taking a treatment can be an obstacle to breastfeeding, but for the particular case of beta-blockers, even if the available data are few and sometimes worrying, the data from this study are reassuring.
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Affiliation(s)
- Romane Freppel
- Centre de Pharmacovigilance Et de Pharmacoépidémiologie, Service de Pharmacologie Médicale, CHU de Lille, Lille, France.
| | - Louise Gaboriau
- Centre de Pharmacovigilance Et de Pharmacoépidémiologie, Service de Pharmacologie Médicale, CHU de Lille, Lille, France
| | - Marjorie Richardson
- Service d'explorations Fonctionnelles Cardiovasculaires, Institut Cœur Poumon, CHU Lille, Lille, France
| | - Yasmine Ould
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - Olivia Domanski
- Service de Cardiologie Pédiatrique et Congénitale, CHU Lille, Lille, France
| | - Claire Pinçon
- ULR2694 (METRICS : Évaluation des Technologies de Santé et des Pratiques Médicales), Univ. Lille, CHU Lille, 59000, Lille, France
| | - Louise Ghesquière
- Department of Obstetrics, F-59000 Lille, France; Univ. Lille, ULR2694 - METRICS - Health Technology and Medical Practice Assessment, CHU Lille, F-59000, Lille, France
| | - Sophie Gautier
- Centre de Pharmacovigilance Et de Pharmacoépidémiologie, Service de Pharmacologie Médicale, CHU de Lille, Lille, France
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Tanana L, Latif A, Nishtala PS, Chen TF. Investigating Variations in Medicine Approvals for Attention-Deficit/Hyperactivity Disorder: A Cross-Country Document Analysis Comparing Drug Labeling. J Atten Disord 2024; 28:1437-1453. [PMID: 38327043 PMCID: PMC11328451 DOI: 10.1177/10870547231224088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This study aimed to compare the approval of medicines for attention deficit/hyperactivity disorder (ADHD) for pediatric patients across five countries. METHOD A document analysis was completed, using the drug labeling for ADHD medicines from five countries; United Kingdom, Australia, New Zealand, Canada and United States (US). Comparisons of available formulations and approval information for ADHD medicine use in pediatric patients were made. RESULTS The US had the highest number of approved medicines and medicine forms across the studied countries (29 medicine forms for 10 approved medicines). Approved age and dosage variations across countries and missing dosage information were identified in several drug labeling. CONCLUSIONS The discrepancies in approval information in ADHD medicine drug labeling and differing availability of medicine formulations across countries suggest variations in the management of ADHD across countries. The update of drug labeling and further research into reasons for variability and impact on practice are needed.
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Affiliation(s)
- Laila Tanana
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Asam Latif
- University of Nottingham, Nottingham, UK
| | | | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Vinogradov R, Holden E, Patel M, Grigg R, Errington L, Araújo-Soares V, Rankin J. Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence. PLoS One 2024; 19:e0302720. [PMID: 38701053 PMCID: PMC11068207 DOI: 10.1371/journal.pone.0302720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention. MATERIALS AND METHODS A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'. RESULTS From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'. CONCLUSIONS The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention. TRIAL REGISTRATION PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718.
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Affiliation(s)
- Raya Vinogradov
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute of Health and Care Research Applied Research Collaboration North East and North Cumbria, Newcastle, United Kingdom
- Research Directorate, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Eleanor Holden
- Public Contributor and Expert by Experience, London, United Kingdom
| | - Mehali Patel
- Public Contributor and Expert by Experience, London, United Kingdom
- Stillbirth and Neonatal Death Society (Sands), Charitable Organisation, London, United Kingdom
| | - Rowan Grigg
- Public Contributor and Expert by Experience, London, United Kingdom
- Action on Pre-eclampsia (APEC), Charitable Organisation, Evesham, United Kingdom
| | - Linda Errington
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Vera Araújo-Soares
- Medical Faculty Mannheim, Division of Prevention, Center for Preventive Medicine and Digital Health (CPD), Heidelberg University, Heidelberg, Germany
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- National Institute of Health and Care Research Applied Research Collaboration North East and North Cumbria, Newcastle, United Kingdom
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Herzig M, Eisenhofer S, Ruschkowski M, Neubert A, Bertsche A, Bertsche T, Neininger MP. Authorized or Off-Label Use? A Structured Analysis of Summaries of Product Characteristics with Regard to Authorization in Pediatrics. Pharmaceut Med 2024; 38:205-216. [PMID: 38555544 PMCID: PMC11101375 DOI: 10.1007/s40290-024-00519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The Summary of Product Characteristics (SmPC) is required to provide unambiguous information on the authorized use of a medicinal product. Therefore, we performed a structured analysis of the information provided for pediatric patients in current SmPCs. METHODS In the German SmPC of the medicinal products of 452 active substances, we analyzed for each of the listed indications whether information on pediatric use was available in Sects. 4.1-4.4 of the SmPC and, if so, whether it was unambiguous. Information was considered unambiguous if it indicated an exact age- or weight-related specification. The analysis also considered the type of marketing authorization and the date of marketing authorization, either before or after the Pediatric Regulation 2007 came into force. RESULTS Among the 30,354 identified indications in 8464 SmPCs, unambiguous information was found for 72.4% (21,974/30,354) of the indications. Of these, 45.4% (9967/21,974) disclosed a contraindication for the entire population under 18 years of age. The proportion of unambiguous information was higher for medicinal products with centralized marketing authorization (86.5% [1449/1676]) than for those with a national one (71.6% [20,525/28,678]; p < 0.001). A higher proportion of unambiguous information was found for the marketing authorization period 2007-2021 compared with 1996-2006 (1996-2006: 63.8% [7466/11,694]; 2007-2021: 82.1% [12,349/15,040]; p < 0.001). CONCLUSION For about a quarter of all indications, no or only ambiguous information was available for pediatric patients. The measures initiated in recent years to increase pediatric-specific information in SmPCs should be intensified in order to improve drug safety in children and adolescents.
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Affiliation(s)
- Markus Herzig
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Simone Eisenhofer
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Meike Ruschkowski
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
| | - Antje Neubert
- Department of Pediatric and Adolescent Medicine, University Hospital Erlangen, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Astrid Bertsche
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany.
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103, Leipzig, Germany
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Reitan Riibe S, Heitmann K, Schjøtt J, Riedel B. Healthcare professionals' information need related to antiseizure medication use in breastfeeding patients with epilepsy. Retrospective analysis of enquiries to Norwegian medicines information and pharmacovigilance centers. Epilepsy Behav Rep 2023; 24:100629. [PMID: 37954010 PMCID: PMC10632412 DOI: 10.1016/j.ebr.2023.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023] Open
Abstract
Background Safety information of antiseizure medication (ASM) during breastfeeding is scarce and conflicting. We aimed to identify characteristic traits of safety concerns among healthcare professionals by reviewing enquiries to the Norwegian Regional Medicines Information and Pharmacovigilance Centres (RELIS). Method Enquiries related to breastfeeding, epilepsy, and ASM identified by their ATC-numbers were retrieved from the RELIS database of question-and-answer pairs (QAPs) by combining indexed and Boolean database searches and manual inspection. 112 QAPs were analyzed retrospectively using descriptive statistics. Results Hospital-employed physicians and nurses were puzzled by ambiguous or conflicting drug information advice and called for general information about the compatibility of an ASM with breastfeeding, mainly related to lamotrigine and levetiracetam. Other enquiries were related to co-medication with other drugs, mainly antidepressants. Half of the enquiries were posed after birth, 12 of these motivated by suspected adverse events in the infants. Conclusion Healthcare professionals with acknowledged high competence in the topic were uncertain about the prevailing safety information of ASM during breastfeeding. The fear to harm the infant may lead to the decision not to recommend breastfeeding. Future information strategies should aim to reach these professions, and support their information need on this topic.
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Affiliation(s)
- Sunniva Reitan Riibe
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Sandnessjøen Helgeland Hospital, Prestmarkveien 1, 8800 Sandnessjøen, Norway
| | - Kristine Heitmann
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, 5021 Bergen, Norway
| | - Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, 5021 Bergen, Norway
| | - Bettina Riedel
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway
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Roque Pereira L, Durán CE, Layton D, Poulentzas G, Lalagkas PN, Kontogiorgis C, Sturkenboom M. A Landscape Analysis of Post-Marketing Studies Registered in the EU PAS Register and ClinicalTrials.gov Focusing on Pregnancy Outcomes or Breastfeeding Effects: A Contribution from the ConcePTION Project. Drug Saf 2022; 45:333-344. [PMID: 35357659 PMCID: PMC9021095 DOI: 10.1007/s40264-022-01154-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
Introduction A large proportion of medicine product labels lack information on safety in pregnancy and breastfeeding. To address this gap, pharmaceutical companies are requested to develop post-approval studies regarding the use of drugs by pregnant and breastfeeding women. Objective Our study aims to review key features of observational studies in pregnancy and breastfeeding and their impact on the respective medicine product labels. Methods Observational studies focusing on the safety evaluation of medicines used during pregnancy and breastfeeding were selected from the European Union Register of Post-Authorization Studies (EU PAS register) and ClinicalTrials.gov. We extracted information on the variables of interest and performed an impact assessment on the respective label. Results A total of 141 observational studies were eligible. Of these, 63 studies (45%) were based on primary data collection and 55 studies (39%) on secondary use of health data. A small number of studies (8%) aimed to evaluate drug safety during breastfeeding. Studies using secondary data collection lasted around 2.9 years as opposed to 7.5 years’ duration for studies using primary data collection. Only two product labels were updated based on the study results. Conclusion The duration is significantly longer for studies based on primary data collection, and these are also smaller in size (less power), whereas outcomes of interest are similar. For completed studies, the impact on the label was very low. Given the gap in adequate pregnancy information on product labels, the current process of generating evidence in pregnancy and breastfeeding seems neither efficient nor impactful. To support evidence-based decision making by prescribers, this current process might be redesigned. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01154-7.
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Affiliation(s)
- Leonardo Roque Pereira
- Department of Data Science & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Carlos E Durán
- Department of Data Science & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Georgios Poulentzas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis-Nikolaos Lalagkas
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Miriam Sturkenboom
- Department of Data Science & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Drelich E, Religioni U, Chung K, Kaźmierczak J, Blicharska E, Neumann-Podczaska A, Krysiński J, Merks P. The Quality and Reliability of Information in the Summaries of Product Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042185. [PMID: 35206371 PMCID: PMC8872284 DOI: 10.3390/ijerph19042185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
The Summary of Product Characteristics (SmPC) is an obligatory document concerning a medicine required (among other things) for the authorization of a medicinal product. The purpose of the SmPC is to provide product information to healthcare professionals. A necessary condition for this is to ensure that the SmPC is clear and precise. However, neither European nor national legislation obliges marketing authorization holders to review the SmPC in terms of its readability and understandability prior to the registration of a medicine. To date, research on SmPCs has focused on accuracy and completeness; however, the literature lacks information on the extent to which SmPCs meet the needs of healthcare professionals concerning the readability of the information they contain. The main objective of this article is to point out the lack of precision in the legal provisions for the preparation of SmPCs concerning the comprehensibility of the provisions. The article points to the lack of testing of the SmPC in terms of accessibility and transparency for healthcare professionals, highlighting that the document does not meet the needs of healthcare professionals in providing adequate information about medicines. It shows that the current rules and guidelines for the preparation of the registration dossier for a medicinal product are not entirely precise and contain numerous shortcomings.
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Affiliation(s)
- Ewelina Drelich
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland; (E.D.); (J.K.)
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-826 Warsaw, Poland
- Correspondence:
| | - Kevin Chung
- Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Justyna Kaźmierczak
- Zdrowit sp. z o.o., Pharmacy Chain, ul. Diamentowa 3, 41-940 Piekary Śląskie, Poland;
| | - Eliza Blicharska
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland;
| | | | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland; (E.D.); (J.K.)
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
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Florea RM, Sultana CM. COVID-19 and breastfeeding: can SARS-CoV-2 be spread through lactation? Discoveries (Craiova) 2021; 9:e132. [PMID: 34754901 PMCID: PMC8570917 DOI: 10.15190/d.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
SARS-CoV-2 is a new betacoronavirus that was first reported in the Hubei province, China, in December 2019. The virus is likely transmitted through air droplets. However, there are reported cases where SARS-CoV-2-RNA was found in other samples, such as blood or stool. Nonetheless, there is limited information concerning the presence of viral RNA in pregnancy-related samples, specifically breast milk. However unlikely, there is still uncertainty regarding the possibility of vertical transmission from mother to infant through breastfeeding. This review aims to synthetize the literature written so far on this topic.
Despite not being extensively researched, vertical transmission through breast milk seems unlikely. Case series showed that milk samples from mothers with COVID-19 were almost entirely negative. So far, there have been only 9 recorded cases of viral shedding in milk samples, uncertain however of the viability of the particles. Furthermore, WHO and UNICEF strongly encourage commencing breastfeeding after parturition, underlining the benefits of lactation. Moreover, some studies have proven the existence of IgG and IgA anti-SARS-CoV-2-antibodies in the maternal milk that could possibly play an important part in the neonate’s protection against the virus.
Vertical transmission through lactation seems unlikely, most studies pointing towards the safety of breastfeeding. However, further larger-scale studies need to be performed in order to clarify a yet uncertain matter.
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Affiliation(s)
| | - Camelia Madalina Sultana
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Stefan S. Nicolau Virology Institute, Bucharest, Romania
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9
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Pizzol TDSD, Pinto AN, Silveira MPT, Caetano MCDC, Giugliani C. Breastfeeding and drug use: what is the orientation found in drug package inserts of contraceptives and anti-infective agents? CIENCIA & SAUDE COLETIVA 2021; 26:4783-4794. [PMID: 34730663 DOI: 10.1590/1413-812320212610.30702020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
This article aims to evaluate the conformity between drug package inserts (DPIs) and evidence-based bibliographic sources regarding the presence of contraindications to the use of contraceptives and anti-infective agents during breastfeeding. Contraceptive and anti-infectives were selected, according to ATC, with the updated record in the ANVISA and present in the bibliographic sources Breastfeeding and Use of Medicines and Other Substances, Medications and Mother's Milk, LactMed®, Micromedex® and UpToDate®. Information was extracted from the DPI "Contraindications" and "Warnings and precautions" sections and compared with the information in the bibliographic sources. The contraindication of the drug during breastfeeding was evaluated. Contraindications were found in the DPIs of five (55.5%) of the nine contraceptives. The contraindication percentage ranged from 0 to 55.5% among the bibliographic sources, depending on the source. The percentage was 46.3% in the DPIs, ranging from 0 to 12.9% in the bibliographic sources for anti-infectives. There is an agreement between the DPIs and the bibliographic sources regarding contraceptives; regarding anti-infectives, the DPIs are more often contraindicated for use during breastfeeding.
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Affiliation(s)
- Tatiane da Silva Dal Pizzol
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS). Av. Ipiranga 2752, sala 203, Santana. 90610-000 Porto Alegre RS Brasil.
| | - Alessandra Nunes Pinto
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS). Av. Ipiranga 2752, sala 203, Santana. 90610-000 Porto Alegre RS Brasil.
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10
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Tanana L, Latif A, Nishtala PS, Taylor D, Chen TF. An International Comparison of the Information in the Regulatory-Approved Drug Labeling and Prescribing Guidelines for Pediatric Depression. J Child Adolesc Psychopharmacol 2021; 31:294-309. [PMID: 33601936 DOI: 10.1089/cap.2020.0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: To determine the differences in information between prescribing guidelines and drug labeling, as well as to compare the approval of psychotropic medicines for major depression in pediatric patients ("pediatric depression") across countries. Methods: The recommendations of The Maudsley Prescribing Guidelines in Psychiatry (MPGP) for the treatment of pediatric depression (<18 years) were compared against the regulatory-approved drug-labeling documents from the United Kingdom, Australia, New Zealand, Canada, and the United States. The use of medicines outside of their regulatory approval is defined as off-label use, so differences between the drug labeling and MPGP were characterized according to unapproved age, indication, dosage, or route of administration. Information in the drug labeling was also compared across countries. Results: MPGP provides recommendations for 6 medicines for the treatment of pediatric depression, for which, 30 drug labeling were retrieved. Three of 30 drug labeling were consistent with MPGP recommendations (fluoxetine in the United Kingdom, fluoxetine and escitalopram in the United States). Differences in information between MPGP and the drug labeling were identified in 26 of 30 drug labeling analyzed, most often due to age (24/26) followed by indication (2/26). No differences pertaining to dosage or route of administration information were identified. The number of approved psychotropic medicines varied across the studied countries and we found cross-country discrepancies in information in the drug labeling. Conclusion: Significant differences in information exists between MPGP and the drug labeling for psychotropic medicines for pediatric depression, due to unapproved ages or indications. Additionally, approval information in the drug labeling are not consistent across countries. Further research into reasons for variability and impact on practice may be warranted.
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Affiliation(s)
- Laila Tanana
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Asam Latif
- School of Health Sciences, Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Prasad S Nishtala
- Department of Pharmacy & Pharmacology, University of Bath, Bath, United Kingdom
| | | | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Houben E, Te Winkel B, Steegers EAP, Herings RMC. Dutch trends in the use of potentially harmful medication during pregnancy. Br J Clin Pharmacol 2020; 86:2377-2392. [PMID: 32374086 PMCID: PMC7688525 DOI: 10.1111/bcp.14341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/18/2020] [Accepted: 03/18/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Recent population‐based data on drug utilization around pregnancy are lacking. This study aims to examine the prevalence of drug exposure in the Netherlands during the preconception, pregnancy and postpartum periods, with special emphasis on trends of potentially harmful medication over the years. Methods A population‐based study was conducted using records from the PHARMO Perinatal Research Network. From 1999 to 2017, the proportion of pregnancies during which women used any medication or potentially harmful medication was assessed, overall and stratified by timing of exposure relative to pregnancy and by the year of delivery. Results Overall, 357 226 (73%) and 166 484 (34%) of 487 122 selected pregnancies were exposed to any and potentially harmful medication, respectively. Among these 487 122 pregnancies, preconception prevalence for use of potentially harmful medication was 43%, 24% during the first trimester, 19% during the second, 16% during the third, and 45% postpartum. A declining trend was observed for exposure to any medication, from 84% in 1999 to 68% in 2017. No clear changes were observed over time for the proportion of pregnancies exposed to potentially harmful medication. Conclusions Our study shows that the use of potentially harmful medication was high over the last two decades. Although there was a declining trend over the years in overall medication use, during a steady one‐third of pregnancies, women used potentially harmful medication. Our findings highlight the need for an increased sense of urgency among both healthcare providers and women of reproductive age regarding potential risks associated with pharmacological treatment during pregnancy.
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Affiliation(s)
- Eline Houben
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Bernke Te Winkel
- Teratology Information Service Netherlands, Pharmacovigilance Centre Lareb, s-Hertogenbosch, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Aurich B, Martin-Montoya T, Zhang D, Jacqz-Aigrain E. Reporting of offspring data in diabetes, HIV infection and hypertension trials during pregnancy: a systematic review. Arch Dis Child Fetal Neonatal Ed 2020; 105:215-221. [PMID: 31597728 DOI: 10.1136/archdischild-2019-316982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical trials are conducted during pregnancy to evaluate benefits and risks of medicines for mother and child. The safety of maternal treatments is a key issue for healthcare professionals and parents. OBJECTIVE To analyse offspring data reported in clinical trials in pregnant women with diabetes, HIV infection or hypertension (three of the most common diseases in women of childbearing potential) and either treated prior to pregnancy for these chronic diseases or diagnosed and treated during pregnancy. METHODS PubMed and Embase (1 January 1997 to 31 December 2017) were searched for drug trials in pregnant women with diabetes, HIV infection or hypertension. Titles and abstracts were screened, followed by a full-text review of eligible articles. Inclusion criteria were interventional clinical trials in pregnant women treated with medication and full text in English. Trial characteristics, maternal and offspring data were extracted. Data were summarised by disease and study. Twelve key items were considered for the offspring. RESULTS Overall, 196 articles reporting 132 clinical trials (diabetes n=55; HIV n=59; hypertension n=18) were included. Key offspring data were frequently not reported, for example, number of births (diabetes: 22/55, 40%; HIV: 14/59, 24%; hypertension: 10/18, 56%). Congenital malformations were often not reported with sufficient detail (diabetes: 40/55, 73%; HIV: 39/59, 66%; hypertension: 17/18, 94%). Similar observations were made for other key items (eg, fetal losses, neonatal deaths). CONCLUSION Under-reporting of key data for the offspring was frequent in publications of clinical trials in pregnant women with diabetes, HIV infection or hypertension making the assessment of the benefit-risk ratio of treatment options during pregnancy difficult. TRIAL REGISTRATION NUMBER CRD42017057024.
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Affiliation(s)
- Beate Aurich
- Pediatric Pharmacology and Pharmacogenetics, Hopital Universitaire Robert Debre, Paris, France
| | - Tania Martin-Montoya
- Pediatric Pharmacology and Pharmacogenetics, Hopital Universitaire Robert Debre, Paris, France
| | - Daolun Zhang
- Pediatric Pharmacology and Pharmacogenetics, Hopital Universitaire Robert Debre, Paris, France
| | - Evelyne Jacqz-Aigrain
- Pediatric Pharmacology and Pharmacogenetics, Hopital Universitaire Robert Debre, Paris, France .,Clinical Investigation Center CIC1426, Hôpital Robert Debre, Paris, France.,Pharmacology, Universite Paris Diderot, Paris, France
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13
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Roldan Munoz S, Lupattelli A, de Vries ST, Mol PGM, Nordeng H. Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study. BMJ Open 2020; 10:e034529. [PMID: 32029496 PMCID: PMC7044950 DOI: 10.1136/bmjopen-2019-034529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases. DESIGN Cross-sectional web-based survey. SETTING Multinational study in Europe. PARTICIPANTS Pregnant women or women with children less than 1 year old from European countries and with asthma, allergy, cardiovascular, rheumatic diseases, diabetes, epilepsy and/or inflammatory bowel diseases (IBD). PRIMARY AND SECONDARY OUTCOME MEASURE Differences in scores of the Beliefs about Medicines Questionnaire (BMQ). RESULTS In total, 1219 women were included (ranging from 736 for allergy to 49 for IBD). Women using medication for their chronic disease (n=770; 63%) had higher scores on the BMQ subscales necessity (16.6 vs 12.1, p<0.001) and benefits (16.2 vs 15.4, p<0.001), and lower values on the subscales overuse (12.5 vs 13.1; p=0.005) and harm (9.8 vs 10.7, p<0.001) than women not using medication. No significant differences were shown for the concerns subscale (12.5 vs 12.3, p=0.484). Beliefs varied somewhat across diseases but in general more positive beliefs among women using medication were shown. Epilepsy was the disease where less differences were observed between women using and not using medication. CONCLUSION Women's beliefs were associated with medication use during pregnancy with only small differences across the diseases. Knowing pregnant women's beliefs could help identify women who are reluctant to use medication and could guide counselling to support making well-informed treatment decisions.
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Affiliation(s)
- Sonia Roldan Munoz
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Angela Lupattelli
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Sieta T de Vries
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedvig Nordeng
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
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14
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Ancuceanu R, Dinu M, Furtunescu F, Boda D. An inventory of medicinal products causing skin rash: Clinical and regulatory lessons. Exp Ther Med 2019; 18:5061-5071. [PMID: 31798726 PMCID: PMC6880410 DOI: 10.3892/etm.2019.7837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/27/2019] [Indexed: 12/16/2022] Open
Abstract
A variety of medicinal products have been associated with rash and normally this information should be available in the Summary of Product Characteristics (SmPCs). Our study aimed to investigate the frequency of rash as an adverse drug reaction, based on the information provided by SmPCs of 1,048 single active substances (international non-proprietary names) authorized in the United Kingdom. Data on rash frequency was collected from each SmPC using automated searches based on selected keywords. Data analysis was carried out using R, v. 3.4. We found that over 90% of the medicines used orally or by injection may be associated with rash as an adverse event, the most common classes being protein kinase inhibitors, anticancer medicinal products, monoclonal antibodies, biologicals, antivirals and retinoids, with high variations in rash frequency for products within the same class, but also for products with the same active substance. Analysis of SmPCs revealed the need to increase homogeneity in reporting rash frequency, by using Council for International Organizations of Medical Sciences classification, and Medical Dictionary for Regulatory Activities coding in a more standardized manner, and also the need to include more safety endpoints in clinical trials and to use better the safety results for publication and updating the SmPCs.
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Affiliation(s)
- Robert Ancuceanu
- Department of Pharmaceutical Botany and Cell Biology, Faculty of Pharmacy, ‘Carol Davila’ University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Mihaela Dinu
- Department of Pharmaceutical Botany and Cell Biology, Faculty of Pharmacy, ‘Carol Davila’ University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Carol Medical Center, 010626 Bucharest, Romania
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15
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Weersink RA, Timmermans L, Monster-Simons MH, Mol PGM, Metselaar HJ, Borgsteede SD, Taxis K. Evaluation of Information in Summaries of Product Characteristics (SmPCs) on the Use of a Medicine in Patients With Hepatic Impairment. Front Pharmacol 2019; 10:1031. [PMID: 31607904 PMCID: PMC6758592 DOI: 10.3389/fphar.2019.01031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background: In 2005, the European Medicines Agency (EMA) released guidance on pharmacokinetic studies in patients with hepatic impairment. This guidance describes the design of these studies and what information should be presented in the Summary of Product Characteristics (SmPC). We aim to evaluate the availability and clinical applicability of information on medicine use in patients with hepatic impairment in SmPCs and registrational dossiers of recently approved medicines. Methods: We reviewed SmPC information on use in patients with hepatic impairment of 51 new medicines authorized between 2015 and 2017. Per medicine, we assessed the availability of nine information items derived from the EMA guidance, i.e. type of hepatic disease studied; stratification by severity of hepatic impairment; influence of hepatic impairment on the pharmacokinetics; safety advice in mild, moderate, and severe hepatic impairments; and dosing recommendation in mild, moderate, and severe hepatic impairments. If unavailable, the European Public Assessment Report (EPAR) and study report were consulted consecutively. Of available items, clinical applicability was assessed by labeling information as "clear" or "ambiguous". Results: Of 51 medicines, 15 had no pharmacokinetic study in patients with hepatic impairment described in their SmPC. The other 36 SmPCs contained on average seven of the nine information items (range 4-9). One SmPC contained all 9 items, and after consulting, the study reports, 11 SmPCs were complete. The item "type of hepatic disease studied" was available in one SmPC, though it could be retrieved in 21 study reports. Regarding clinical applicability, there was no medicine with all information items available and clearly formulated in the SmPC. A total of 12 medicines (33%) contained only clearly formulated information, while 24 (67%) contained at least one ambiguously formulated information item (range 0-4). Items often ambiguously formulated were: "definition of mild, moderate, and severe hepatic impairment" (15 ambiguous SmPCs) and "safety advice in severe hepatic impairment" (17 ambiguous SmPCs). Conclusion: While SmPCs contain a large part of information requested by the EMA, clinical applicability seems low, as it is often unclear to which specific type of hepatic disease patient the advice applies. This can negatively influence the practical use by healthcare professionals.
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Affiliation(s)
- Rianne A Weersink
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands
| | - Lotte Timmermans
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Pharmaceutical and Pharmacological Sciences, Unit of Clinical Pharmacology and Pharmacotherapy, Catholic University of Leuven, Leuven, Belgium
| | - Margje H Monster-Simons
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Peter G M Mol
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Katja Taxis
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
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16
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Pizzol TDSD, Moraes CG, Diello MV, Campos PM, Pletsch JT, Giugliani C. Uso de medicamentos antidepressivos na amamentação: avaliação da conformidade das bulas com fontes bibliográficas baseadas em evidências científicas. CAD SAUDE PUBLICA 2019; 35:e00041018. [DOI: 10.1590/0102-311x00041018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo foi avaliar a conformidade entre as recomendações de uso de medicamentos antidepressivos durante a amamentação, presentes em bulas, e as recomendações de fontes bibliográficas baseadas em evidências científicas. Foram avaliadas as bulas padrão de 23 antidepressivos com registro ativo no Brasil. A presença de contraindicação do uso do antidepressivo durante a amamentação foi comparada com as informações presentes no manual técnico do Ministério da Saúde, no livro Medications and Mothers’ Milk e nas bases de dados LactMed, Micromedex e UpToDate. Na maioria das bulas (62,5%), o antidepressivo é contraindicado na amamentação. Entre as fontes bibliográficas, esse percentual variou de 0% a 25%. O estudo aponta para baixa conformidade entre bulas e fontes bibliográficas, alertando sobre a necessidade de revisão do conteúdo e forma de apresentação das informações presentes nas bulas dos antidepressivos no Brasil.
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17
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Yoon D, Song I, Noh Y, Li J, Shin JY. Consistency of listed indications and contraindications between the U.S., the U.K., Japan, and Korea on prescription drug labels. Regul Toxicol Pharmacol 2018; 98:168-170. [PMID: 30056245 DOI: 10.1016/j.yrtph.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
Inclusion of indications and contraindications in drug labeling is essential for drug approval. Little is known regarding how well new drug information labels agree across countries. To compare the number of indications and contraindications on the labels of drugs in the U.S., U.K., Japan, and Korea, we selected 81 new drugs approved in these countries between 2008 and 2016 and assessed the number of indications and contraindications on each label. Average and median numbers with standard deviations were presented for the 81-drug set, and for subsets grouped according to drug class. Correlation analyses were conducted to estimate Pearson and concordance correlation coefficients. No significant difference was observed across countries in the number of indications, the average being 1.69, 1.67, 1.54, and 1.51 in the U.S., the U.K., Korea, and Japan (p = 0.31), respectively. By contrast, substantial variation was observed in the number of contraindications, the average being 1.54, 2.42, 3.53, and 3.00 in the U.S., the U.K., Korea, and Japan (p < 0.001), respectively. Pearson correlation coefficients comparing contraindications were 0.40, 0.48, and 0.47 for U.S.-U.K., U.S.-Korea, and U.S.-Japan, but 0.83, 0.73, and 0.71 for U.K.-Korea, U.K.-Japan, and Korea-Japan, respectively (p < 0.01). There is consistency in the number of indications, but a substantial discrepancy in contraindications listed in drug labeling across countries. Further study is warranted to improve global harmonization of contraindication listings.
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Affiliation(s)
- Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Junqing Li
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
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18
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Noh Y, Yoon D, Song I, Jeong HE, Bae JH, Shin JY. Discrepancies in the Evidence and Recommendation Levels of Pregnancy Information in Prescription Drug Labeling in the United States, United Kingdom, Japan, and Korea. J Womens Health (Larchmt) 2018; 27:1086-1092. [DOI: 10.1089/jwh.2017.6792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yunha Noh
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Dongwon Yoon
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Inmyung Song
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Han Eol Jeong
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ji Hwan Bae
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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Stephens A, Brodribb W, McGuire T, Deckx L. Breastfeeding questions to medicines call centres from the Australian public and health professionals. Aust J Prim Health 2018; 24:409-416. [PMID: 30086825 DOI: 10.1071/py18010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/24/2018] [Indexed: 01/04/2023]
Abstract
There is considerable uncertainty regarding medication use during breastfeeding. This study compared lactation-related questions about medicines from consumers and health professionals to identify knowledge gaps. A retrospective, mixed-methods study of lactation-related call data extracted from two Australian medicines call centre databases: National Prescribing Service (NPS) Medicines Line (ML) for the general public and Therapeutic Advice and Information Service (TAIS) for health professionals, was conducted. Of the 5662 lactation-related calls by consumers to ML, most were from women enquiring about themselves (95%). The 2219 lactation-related calls from health professionals to TAIS were largely from GPs (46%), community pharmacists (35%) and nurses (12%). Consumers commonly enquired about medicines freely accessible or over-the-counter, including non-steroidal anti-inflammatory products (9.3%), paracetamol (6.9%), ibuprofen (4.8%) and codeine (4.2%). Health professionals' questions involved prescription medicines such as antidepressants (16.9%), with queries on sertraline (3.7%), levonorgestrel (2.7%) and domperidone (2.4%) most common. Question themes were similar for both cohorts, focusing mainly around medication safety, risk minimisation and milk supply. Understanding the compelling and common themes driving medicines help-seeking related to breastfeeding is key to addressing information gaps and improving overall medication use during breastfeeding.
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Affiliation(s)
- Amelia Stephens
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Health Sciences Building 16/910, Royal Brisbane & Women's Hospital, Brisbane, Qld 4029, Australia
| | - Wendy Brodribb
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Health Sciences Building 16/910, Royal Brisbane & Women's Hospital, Brisbane, Qld 4029, Australia
| | - Treasure McGuire
- Mater Pharmacy Services, Mater Health Services, Brisbane, Qld 4101, Australia
| | - Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Health Sciences Building 16/910, Royal Brisbane & Women's Hospital, Brisbane, Qld 4029, Australia
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20
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Jahnsen JA, Widnes SF, Schjøtt J. Analysis of questions about use of drugs in breastfeeding to Norwegian drug information centres. Int Breastfeed J 2018; 13:1. [PMID: 29339968 PMCID: PMC5759832 DOI: 10.1186/s13006-017-0143-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/18/2017] [Indexed: 01/16/2023] Open
Abstract
Background Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice. Methods A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with “BREASTFEEDING” in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used. Results In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician. Conclusions This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug. Electronic supplementary material The online version of this article (10.1186/s13006-017-0143-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Anker Jahnsen
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
| | - Sofia Frost Widnes
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
| | - Jan Schjøtt
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.,Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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21
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Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
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Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
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22
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Ontology-based systematical representation and drug class effect analysis of package insert-reported adverse events associated with cardiovascular drugs used in China. Sci Rep 2017; 7:13819. [PMID: 29061976 PMCID: PMC5653862 DOI: 10.1038/s41598-017-12580-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/07/2017] [Indexed: 01/31/2023] Open
Abstract
With increased usage of cardiovascular drugs (CVDs) for treating cardiovascular diseases, it is important to analyze CVD-associated adverse events (AEs). In this study, we systematically collected package insert-reported AEs associated with CVDs used in China, and developed and analyzed an Ontology of Cardiovascular Drug AEs (OCVDAE). Extending the Ontology of AEs (OAE) and NDF-RT, OCVDAE includes 194 CVDs, CVD ingredients, mechanisms of actions (MoAs), and CVD-associated 736 AEs. An AE-specific drug class effect is defined to exist when all the drugs (drug chemical ingredients or drug products) in a drug class are associated with an AE, which is formulated as a new proportional class level ratio (“PCR”) = 1. Our PCR-based heatmap analysis identified many class level drug effects on different AE classes such as behavioral and neurological AE and digestive system AE. Additional drug-AE correlation tests (i.e., class-level PRR, Chi-squared, and minimal case reports) were also modified and applied to further detect statistically significant drug class effects. Two drug ingredient classes and three CVD MoA classes were found to have statistically significant class effects on 13 AEs. For example, the CVD Active Transporter Interactions class (including reserpine, indapamide, digoxin, and deslanoside) has statistically significant class effect on anorexia and diarrhea AEs.
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23
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Arguello B, Salgado TM, Laekeman G, Fernandez-Llimos F. Development of a tool to assess the completeness of drug information sources for health care professionals: A Delphi study. Regul Toxicol Pharmacol 2017; 90:87-94. [PMID: 28842337 DOI: 10.1016/j.yrtph.2017.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2017] [Accepted: 08/20/2017] [Indexed: 11/27/2022]
Abstract
The aim of this study was to create a standard set of essential drug information items as a tool to assess the completeness of any type of drug information source, regardless of its length, using a Delphi consensus panel of European health care professionals. A compilation of drug-related information items was performed by searching several resources for health care professionals and a final list of 162 items was obtained. Fifty-seven experts in drug information from 23 different European countries were invited to participate in a three-round Delphi technique to obtain consensus on items considered essential and non-essential content of information. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Of the 57 experts invited, 32 completed the first round, 27 the second, and 29 the third. Consensus was achieved for 28.3% of the items in the first round, 49.3% in the second, and 58.3% in the third. The final cumulative consensus was 67.7% (n = 126) for items considered essential and 16.1% (n = 30) for items considered non-essential. The final tool obtained to assess the completeness of drug information sources was composed by 126 essential items grouped into 11 sections. This tool allows for the comparison of different information sources for the same medicine and the information content for different medicines in the same source.
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Affiliation(s)
- Blanca Arguello
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | - Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street P.O. Box 980533, Richmond, VA 23298-0533, United States
| | - Gert Laekeman
- Clinical Pharmacology and Pharmacotherapeutics, Faculty of Pharmaceutical Sciences, KU Leuven, O&N II, Herestraat 49, PO Box 521, 3000 Leuven, Belgium
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social-Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
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24
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Comparing cytochrome P450 pharmacogenetic information available on United States drug labels and European Union Summaries of Product Characteristics. THE PHARMACOGENOMICS JOURNAL 2016; 17:488-493. [PMID: 27241061 DOI: 10.1038/tpj.2016.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/04/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022]
Abstract
Regulatory agencies are increasing the pharmacogenomic information in their official drug labeling. However, despite the importance of regulatory harmonization, this implementation may not be running in parallel among major agencies. Comparing labeling of medicines approved by different agencies may identify gaps to solve. Our study compared the cytochrome P450 pharmacogenetic information included in the United States (US) Food and Drug Administration (FDA) drug labels and European Union (EU) Summaries of Product Characteristics (SmPCs). US labels presented significantly more specific pharmacogenetic subheadings (51 vs 26%), more prevalence and pharmacokinetic data for each metabolic phenotype (59 vs 25% and 82 vs 48%, respectively) and more applicable information about dose modifications required (25 vs 5%). Approximately 75% of the US labels evaluated scored higher on the overall quality than the analogous EU SmPCs, and this difference was not associated with the time since the EU SmPCs' last review. To enhance harmonization, regulatory agencies should simultaneously introduce the pharmacogenetic information in their drug labeling.
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Fernandez-Llimos F. Quality of drug information for healthcare professionals: The ARCA acronym. Pharm Pract (Granada) 2016; 13:709. [PMID: 26759623 PMCID: PMC4696126 DOI: 10.18549/pharmpract.2015.04.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fernando Fernandez-Llimos
- Editor-in-chief, Pharmacy Practice. Institute for Medicines Research (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon . Lisbon ( Portugal ).
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de Fays L, Van Malderen K, De Smet K, Sawchik J, Verlinden V, Hamdani J, Dogné JM, Dan B. Use of paracetamol during pregnancy and child neurological development. Dev Med Child Neurol 2015; 57:718-24. [PMID: 25851072 DOI: 10.1111/dmcn.12745] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/13/2022]
Abstract
Paracetamol (acetaminophen) remains the first line for the treatment of pain and fever in pregnancy. Recently published epidemiological studies suggested a possible association between paracetamol exposure in utero and attention-deficit-hyperactivity disorder/hyperkinetic disorder (ADHD/HKD) or adverse development issues in children. However, the effects observed are in the weak to moderate range, and limitations in the studies' design prevent inference on a causal association with ADHD/HKD or child neurological development. In parallel, recent animal data showed that cognition and behaviour may be altered following exposure to therapeutic doses of paracetamol during early development. These effects may be mediated by interference of paracetamol with brain-derived neurotrophic factor, neurotransmitter systems (including serotonergic, dopaminergic, adrenergic, as well as the endogenous endocannabinoid systems), or cyclooxygenase-2. However, no firm conclusion can be made on the relevance of these observations to humans. We conclude that additional well-designed cohort studies are necessary to confirm or disprove the association. In the context of current knowledge, paracetamol is still to be considered safe in pregnancy and should remain the first-line treatment for pain and fever.
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Affiliation(s)
- Laurence de Fays
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen Van Malderen
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen De Smet
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Javier Sawchik
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Veerle Verlinden
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Jamila Hamdani
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | | | - Bernard Dan
- Laboratory of Neurophysiology and Biomechanics of Movement, ULB Neuroscience Institut, Université Libre de Bruxelles, Brussels, Belgium
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