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Antidepressants May Raise Risk For Pregnancy Complication

March 27, 2012 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

Use tied to maternal high blood pressure, study finds, but benefits may still outweigh risks Source: 3.22.12 – Steven Reinberg

Pregnant women taking the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) face a slightly increased risk of developing dangerously high blood pressure, Canadian researchers report.

This condition, known as preeclampsia, can harm both mothers and their unborn infants, the researchers noted. However, this association may not be cause-and-effect, so women should not just stop taking these medications but should consult with their doctor if they are concerned, they stressed. Two of the most commonly prescribed SSRIs are Paxil (paroxetine) and Prozac (fluoxetine).

“We know that antidepressants should be used during pregnancy, but they should be used with caution,” said lead researcher Anick Berard, director of the research unit of medications and pregnancy at CHU Ste-Justine’s Research Center and a professor with the Faculty of Pharmacy at the University of Montreal.

The association between SSRIs and hypertension is a new finding, she added.

The report was published in the March 22 issue of the British Journal of Clinical Pharmacology.

For the study, Berard and her colleague, Mary De Vera, collected data on women in the Quebec Pregnancy Registry. They looked at more than 1,200 women who had high blood pressure during pregnancy that did or did not result in preeclampsia and who had no history of high blood pressure before pregnancy, and compared them with more than 12,000 healthy women.

They found women taking SSRIs had a 60 percent higher risk of developing high blood pressure. In absolute terms, the risk went up from 2 percent to 3.2 percent.

It appears that all SSRIs are not equal when it comes to risk, however. For instance, for women taking Paxil the risk was increased 81 percent, or to 3.6 percent in absolute terms.

“It’s a big relative increase, but if you look at absolute risk it is 1 percent,” Berard said.

These findings are important because SSRIs are the most common drugs used to treat depression, and of the estimated 20 percent of women who suffer from depression during pregnancy, between 4 percent and 14 percent take antidepressants, the researchers said.

Commenting on the study, Dr. Gene Burkett, a professor of obstetrics and gynecology at the University of Miami Miller School of Medicine, said that “this study has severe limitations. There are a lot of factors in preeclampsia they do not account for, so they don’t show a cause-and-effect relationship.”

However, pregnant women should be concerned about SSRIs for a lot of other reasons, he said. The medications have been linked to lower birth weights, he noted.

“Every physician has to measure the risk of taking an SSRI vs. the risk of not taking it in patients who really need it,” Burkett said.

“If the patient is really in need of it, then you have to give it to them, because the consequences, especially after delivery, of those patients who are depressed can be anything up to suicide or killing their infant; these are the extremes,” he said.

“We do see cases of women whose depression gets worse after delivery and wind up killing their babies,” he said. “Those patients benefit from SSRIs, and the benefits may be greater than the risks of not taking them.”

However, many women with mild depression may be able to cope without SSRIs, Burkett said. “But if you do take a woman off an SSRI during pregnancy, they need to be followed closely,” he noted.

“In some cases you cannot take women off SSRIs; in other cases you can; you have to evaluate each woman individually,” Burkett said.

Research published earlier this month also found risks associated with SSRI use during pregnancy. Dutch doctors reported that the medications were associated with delayed head growth of the fetus.

“Fetal body growth is a marker of fetal health, and fetal head growth is a marker for brain development,” said lead researcher Hanan El Marroun, a postdoctorate fellow in the department of child and adolescent psychiatry at Sophia Children’s Hospital and Erasmus Medical Center in Rotterdam. “We found prenatal exposure to SSRIs was associated with decreased growth of the head, but not decreased growth of the body.”

Employers to Encourage Generic Medications

April 16, 2010 By: Nadia Category: Medtipster, Prescription News, Prescription Savings Source: Managed HealthCare Executive, April 16, 2010

Survey: employers to encourage generic medications

CVS Caremark has announced the results of its annual employer client benefit survey about priorities for pharmacy benefit management (PBM) services in the coming year. The majority of employers surveyed (94%) said they will seek opportunities to improve savings even more in 2010, while they look for ways to improve the overall member experience. Employers listed price (86%), customer service (86%), trust and reliability (84%) and consumer engagement capabilities (46%) as key priorities for their PBM procurement strategy.

The economic environment continues to impact companies, with 66% of respondents answering that reducing overall healthcare costs is their No. 1 success measure, says Jack Bruner, executive vice president, Strategic Development, CVS Caremark Pharmacy Services.

Survey results show that the majority of employer clients are strongly considering adopting some of the more progressive strategies to encourage the use of lower-cost generic medications. For example, almost half of employers surveyed are considering implementing plan designs that require using a generic medication first before moving to a branded drug (50%) and those that provide members a co-pay waiver to switch to generic medications (56%).

“For our book of business, approximately 35% of brand-spend medications have a generic opportunity,” says Bruner. “Our strategy is to focus on specific therapeutic classes (e.g., proton pump inhibitors, HMG reductase inhibitors, angiotensin II receptor blockers, hypnotic sleep aids, migraine agents, nasal steroids, non-sedating antihistamines, selective serotonin reuptake inhibitors, etc.) where ample generics are available.

According to the survey, a majority of employer clients (88%) and health plan clients (97%) are taking an aggressive or moderate approach toward maximizing generic dispensing in key therapeutic classes as a strategy to increase savings opportunities.

Through 2012, nearly 30 brand-name medications in a variety of classes are expected to become available as generics, including some popular drugs such as Lipitor for treating high cholesterol, according to Bruner.

“We anticipate this will have an impact on opportunities for increasing generic dispensing rate for our clients, resulting in increases savings for clients and their members,” he says.

Bruner expects the rate of employees actually taking advantage of generic substitution/lower-cost alternatives to vary depending on the type of intervention program that is implemented.

“For example, if a client adopts a mandatory generic use program such as step therapy, we see greater than 80% brand to generic substitution/conversion within a therapeutic class,” he says. “If the client implements a generic co-pay waiver to incent brand users to switch to generics, the behavior change rate is less than 10%. However, when a pharmacist counsels a patient at retail or mail about a generic opportunity, the conversion rate is over 30%.”

Compared to the 2009 survey results, the survey found there has been an increase in employers who are adopting or considering solutions to improve medication adherence. In particular, many employer clients are considering programs that impact adherence through counseling and intervention with the member, including: counseling to improve adherence the first time a member fills a maintenance medication (62%), outreach to prescribers to resolve gaps in care (56%) and outreach to members and prescribers to provide counsel about therapy drop-off (65%).

The CVS Caremark client survey was conducted online from Oct. 5, 2009 through Dec. 31, 2009 and includes responses from current CVS Caremark clients representing 285 employers.

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