Debbie Rigby takes a look at the latest in research news
Response to antidepressants in the elderly varies widely from 45% to 80%, compared with 35% to 70% for placebo, with inconsistencies in part owing to use of secondary analysis, variable age cutoffs, and short trials. Efficacy might decrease with patient age. Harms of antidepressants are common, with approximately 20% of patients stopping owing to adverse effects. There is likely no difference in efficacy between TCAs and SSRIs, but withdrawals from treatment owing to adverse effects are higher with TCAs.
Canadian Family Physician May 2019;65(5):340.
A Cochrane review yielded two studies on herbal medicinal products for diabetic neuropathy and non‐diabetic neuropathic pain conditions. Studies explored the effects of nutmeg (applied topically as a 125 mL spray for four weeks, containing mace oil 2%, nutmeg oil 14%, methyl salicylate 6%, menthol 6%, coconut oil and alcohol) and St John’s wort (taken in capsule form containing 900 μg total hypericin each, taken three times daily, giving a total concentration of 2700 mg for five weeks). There was insufficient evidence to determine whether nutmeg or St John’s wort has any meaningful efficacy in neuropathic pain conditions.
Cochrane Database of Systematic Reviews 2019, Issue 4.
Despite the availability of effective therapy, gout remains undertreated, with maintenance of urate-lowering therapy a major challenge. For long-term urate-lowering therapy, allopurinol, probenecid and febuxostat are available in Australia. Lower starting doses of allopurinol are recommended in patients with renal impairment, but dose escalation to achieve target urate should follow.Education of patients and health professionals is essential to improve adherence to therapy.
Journal of Pharmacy Practice and Research 2019;49:90–97.