25 May
Rationale for Development
From the preceding discussion, it is evident that no single agent appears to share all the characteristics of the ideal anti-depressant drug (i.e., rapid onset of action, a short half-life, minimal discontinuation effects, an absence of ADEs, negligible drug interactions, a broad spectrum of activity, and low cost). Efforts to develop better antidepressants are ongoing and are directed at devising a drug that would improve upon the existing SSRIs in terms of safety, tolerability, and efficacy, which in turn would result in an improved pharmacoeconomic profile. The most recent efforts have been aimed at refining the active isomers of existing drugs.
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24 May
One of the most important differences to note among the SSRIs is whether their pharmacokinetic properties are linear or nonlinear. Sertraline and citalopram follow linear pharmacokinetics (i.e., plasma concentrations of the drugs are proportional to the daily dose administered and, therefore, predictable). Fluoxetine and paroxetine canadian demonstrate nonlinear pharmacokinetics (i.e., higher doses may produce much greater increases in plasma drug concentrations than would otherwise be expected). Thus, increasing the dose of parox-etine or fluoxetine can result in disproportionate and unpredictable increases in plasma levels, half-lives, and ADEs. Titration of fluoxetine and paroxetine doses may therefore be more difficult than with sertraline and citalopram.
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23 May
Each drug in the SSRI class has a unique pharmacological and ADE profile. These differences may be important considerations for all patients receiving SSRIs and, as mentioned earlier, are of particular concern for patients who have coexisting medical conditions and who may also be receiving multiple medications, because polypharmacy can increase the potential for drug-drug interactions. Knowledge of the differences that exist among the SSRIs with respect to their safety and tolerability can aid in the selection of the most beneficial treatment.
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22 May
Access to antidepressant medications can vary dramatically. Several studies have been conducted to identify predictors of diagnosis, the use of pharmacotherapy, and the use of the SSRIs. Sociological influences include patient and physician characteristics and their interaction with the health care system.
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21 May
OVERVIEW
Many changes and therapeutic advances have occurred in the treatment of depression in recent years, most notably the availability of the selective serotonin reuptake inhibitor (SSRI) class of agents, followed by the introduction of escitalopram oxalate (Lexapro drug, Forest), the first agent in what is known as the “second generation” of SSRIs. However, because of the higher acquisition cost of SSRIs, compared with earlier antidepressants, managed care plans have begun to implement cost-containment strategies for these agents. As a result, P&T committee members are being asked not only to review efficacy and safety data but also to focus on available pharmacoeconomic data for this class of drugs.
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19 May
To Dr. David B. Nash, Editor-in-Chief
I just read your editorial on adverse drug events (ADEs) and ambulatory care [in the May 2004 issue of P&T]. Thanks for highlighting this most critical area. As you noted, it is easier to identify and do something about ADEs in the acute care setting, but the incidence and prevalence is huge and may even become a more extensive issue with reimportation. Thanks again.
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18 May
You’ve seen her on “CBS News” and “Good Morning America” and on every election eve. Her company, American Viewpoint, regularly takes the “pulse of the nation” to sort out the public’s attitudes on everything from the economy to medication safety. Although I cannot do justice to her dynamic in-person presentations, Linda DiVall has the ear of Washington insiders. I had the privilege of seeing Linda in person during our joint appearances at a recent meeting of the Federation of American Hospitals, the national umbrella organization representing the for-profit hospital sector in Washington, DC.
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