4 controversial meds to be prescribed with caution

Prescribing drugs is a privilege earned only after long years of education and training. Yet, despite a physician’s experience and best intentions, the prescription of certain drugs can be complicated. Some drugs are highly addictive, others carry risks of dangerous side effects. And prescription drug misuse continues to be a serious problem in the United States.

It’s the duty of physicians to approach prescribing with caution—not only for the health of the patient but to minimize the risk of malpractice litigation.

The following are four potentially dangerous medications to watch out for. 

Benzodiazepines

Although the prescription of benzodiazepines is highly controversial, their use is on the rise. After marijuana use, the illicit use of benzodiazepines is most common. (Of note, misuse is defined as use in a manner other than prescribed or use by a person not prescribed the drug.) To address this problem, the FDA announced last fall that it’s requiring all benzodiazepines to carry an updated boxed warning about serious risks of abuse, addiction, physical dependence, and withdrawal reactions.

More than 5% of adult Americans are prescribed benzodiazepines, with use highest in those middle-aged and elderly. Direct adverse effects of these drugs include falls and fractures, and when combined with opioids, the risk of overdose and overdose death both increase. 

Results from a large cross-sectional study published in Psychiatric Services shed light on the scope of the issue. An estimated 30.6 million American adults reported past-year use of benzodiazepines for an overall prevalence of 12.6%—of that, misuse accounted for 2.2%, while 10.4% reported using the drug as prescribed. Misuse was highest among those aged 18 to 25 years (5.2%) and lowest in those aged 65 years or more (0.6%).

Misuse, abuse, or dependence on prescription opioids or stimulants was strongly linked with benzodiazepine misuse. Those who misused often gained access to the drug via a relative or friend with a prescription. Compared with younger adults, adults aged 50 years or more were more likely to take benzodiazepines at higher dosages than prescribed or use them as sleep aids. 

“Clinicians should recognize their role as a source of misused benzodiazepines, either through medication that they prescribe but that is used other than as instructed, or as the source of prescribed medication given for misuse to a friend or relative,” the authors wrote. 

Moreover, clinicians should attempt to understand the reason for their patients’ misuse to determine the appropriate intervention. For example, if patients are consuming prescribed medication faster than expected, what is the reason? Are they not getting adequate symptom control? The medication may have been prescribed for anxiety but are they also using it for insomnia?  

The authors also suggested that physicians be on the lookout for benzodiazepine diversion to relatives who may need the drugs for sleep or so forth and are uninsured. The authors also noted that benzodiazepine misuse may stem from inadequate access to behavioral therapies. 

Click here to read about how benzodiazepines and other drugs can mimic dementia, at MDLinx.

Antibiotics

By only prescribing antibiotics in an evidence-based manner, you not only help your patients, but your surrounding community, and the world. Although antibiotic resistance can affect anyone, the phenomenon is rapidly accelerated by overprescription and misuse. Antibiotic resistance results in longer hospital stays, mushrooming health care costs, and increased death. Pneumonia, tuberculosis, gonorrhea, and salmonellosis are all becoming more challenging to treat due to antibiotic resistance.

According to the WHO, “The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.”

In addition to playing a major role in antibiotic resistance, the long-term effects of antibiotic use are disconcerting as well. 

At the ESMO World Congress, Scottish investigators presented research detailing how antibiotics may increase the risk of colon cancer—particularly in those aged 50 years or younger.

"To our knowledge, this is the first study to link antibiotic use with the growing risk of early onset colon cancer—a disease which has been increasing at a rate of at least 3% per year over the last two decades,” said author Sarah Perrott in a press release. “Junk food, sugary drinks, obesity and alcohol are likely to have played a part in that rise, but our data stress the importance of avoiding unnecessary antibiotics, especially in children and young adults," 

For more about the potential long-term consequences of antibiotic use—including depression and obesity—read this article. 

Stimulants

Even though the prevalence of ADHD has plateaued during the past 30 years, prescriptions of sympathomimetic stimulants in the United States have continued to increase. Psychostimulants have adverse effects and can cause increases in heart rate and blood pressure, as well as arrhythmia, nonischemic cardiomyopathy, Takotsubo cardiomyopathy, and sudden death.

The authors of a systematic review published in the Journal of the American College of Cardiology noted a dearth of randomized-controlled studies with respect to the cardiovascular side effects of stimulants, however, they do caution against overprescription.

“ADHD medications should be prescribed only after safer options, such as regular exercise and omega-3, have been considered and/or tried,” they concluded.

Read Most dangerous prescription medications to learn more about the risks of stimulants, at MDLinx.

Combination antifungal therapies

There has been a rise in the number of invasive fungal infections—especially among transplant recipients and those with hematologic malignancies, as well as other types of immunosuppression. Worryingly, innovation represented by the development of invasive fungal infections lags behind the rate of antifungal resistance. 

Clinicians attempt to shore up any shortcomings in antifungal treatment by combining agents. Nevertheless, various randomized controlled trials have demonstrated lower efficacy and increased cost of this approach, according to the authors of a review published in the Journal of Clinical Medicine Research.

“The lack of consensus in many clinical scenarios raises the importance of the need for more studies about combination antifungal therapies and should incite infectious disease societies to develop specific recommendations for the clinicians to follow while approaching patients with invasive fungal infections,” they wrote.

Want to learn more about drugs? Check out Top 10 medication errors and hazards at MDLinx.