Amitriptyline Inappropriately Prescribed for Neuropathic Pain
LAUSANNE, Switzerland—Almost 1 of every 2 patients who are given an amitriptyline prescription for neuropathic pain has ≥1 contraindications to its use, investigators reported at the 16th meeting of the European Neurological Society.
Mugdha Gore, BPharm, PhD, principal consultant, Avalon Health Solutions, Philadelphia, Pa, and associates reviewed the records of 13,456 patients with neuropathic pain disorder who had received ≥1 prescription for amitriptyline during a recent 3-year period.
Although several tricyclic antidepressants are also used for neuropathic pain, the investigators restricted their analysis to amitriptyline, because it was given to 95% of the cohort.
Overall, 47% of the patients met ≥1 contraindication, warning, or precaution against amitriptyline use or were taking ≥1 medication that should not have been used concomitantly with amitriptyline.
Dr Gore noted that these results point to the need for better physician education about the optimal use of pharmacotherapy for neuropathic pain.
Obesity Leads to Kidney Failure
STOCKHOLM—Chronic renal failure is significantly more likely to occur in obese individuals, according to a report published in the Journal of the American Society of Nephrology (2006;17: 1695-1702).
Elisabeth Ejerblad, MD, of Uppsala University, Stockholm, Sweden, and colleagues compared 926 patients who had severe chronic renal failure with 998 matched healthy controls with normal kidney function.
Data were collected in face-to-face interviews as well as written questionnaires covering anthropometric measures and other lifestyle factors.
Results showed that those who were overweight at age 20 had a 3 times higher risk of chronic renal failure than those with a body mass index (BMI) <25 kg/m2.
In addition, obesity (defined as a BMI >30 kg/m2) in men and morbid obesity (defined as a BMI >35 kg/m2) in women conferred a 3- to 4-fold greater risk of chronic renal failure.
Dr Ejerblad observed that these data demonstrate that chronic renal failure is yet another health consequence of obesity.
Risedronate Benefits Men with Osteoporosis
TORONTO—The bisphosphonate risedronate (Actonel) appears to be safe and effective for the treatment of osteoporosis in men, according to the results of a study presented at the International Osteoporosis Foundation World Congress on Osteoporosis.
A phase 3 study that included 284 men with osteoporosis showed that 2 years of risedronate, 35 mg/day, increased lumbar spine bone mineral density by 4.5% compared with placebo (P <.001). In addition, there were significant decreases in bone turnover markers at all time points measured (3, 6, 12, and 24 months).
Risedronate was well tolerated, with similar side effect rates in the treatment and placebo groups.
“Osteoporosis is a widely underrecognized and underdiagnosed condition,” Steven Boonen, MD, of Leuven University Center for Metabolic Bone Diseases, Leuven, Belgium, noted. “If approved for the treatment of male osteoporosis, risedronate would provide a valuable new treatment option for some patients.”
About 2 million American men have osteoporosis, while another 12 million men are at risk for the disease.
Medical Students Cannot Substitute for Hospital Physicians
ADELAIDE, Australia—Government health officials in Australia are calling for an immediate end to the hiring of medical students by some public hospitals to work as substitute doctors.
“Doctors are alarmed at reports that final-year students have been employed to fill medical workforce shortages and have at times been left without supervision and asked to undertake tasks that should only be performed by fully qualified doctors,” said Choong-Siew Young, MD, vice president of the Australian Medical Association.
“Medical students are not substitutes for doctors, and they should not be expected to fill roles for which they are not yet ready. Employing students as doctors risks patient safety, risks the future medical registration of the student, and brings up a lot of legal and medical indemnity issues,” Dr Young added.
While his organization acknowledges that medical students need a regular income and have a place in hospitals, Dr Young emphasized that they are not qualified to work as physicians.
He added that public hospitals need to focus on recruiting and retaining doctors who can both manage the care of patients and provide training and supervision for students.