1
|
Safari D, DeMarco EC, Scanlon L, Grossberg GT. Over-The-Counter Remedies in Older Adults: Patterns of Use, Potential Pitfalls, and Proposed Solutions. Clin Geriatr Med 2021; 38:99-118. [PMID: 34794706 DOI: 10.1016/j.cger.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.
Collapse
Affiliation(s)
- Delavar Safari
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA.
| | - Elisabeth C DeMarco
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
| | - Lillian Scanlon
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
| | - George T Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
| |
Collapse
|
2
|
|
3
|
Claps M, Cerri S, Grisanti S, Lazzari B, Ferrari V, Roca E, Perotti P, Terzolo M, Sigala S, Berruti A. Adding metyrapone to chemotherapy plus mitotane for Cushing's syndrome due to advanced adrenocortical carcinoma. Endocrine 2018; 61:169-172. [PMID: 29019062 DOI: 10.1007/s12020-017-1428-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mélanie Claps
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Sara Cerri
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Barbara Lazzari
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Vittorio Ferrari
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Elisa Roca
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Paola Perotti
- Internal Medicine 1, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, Torino, Italy
| | - Massimo Terzolo
- Internal Medicine 1, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin, Torino, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
| |
Collapse
|
4
|
Veytsman I, Nieman L, Fojo T. Management of endocrine manifestations and the use of mitotane as a chemotherapeutic agent for adrenocortical carcinoma. J Clin Oncol 2009; 27:4619-29. [PMID: 19667279 DOI: 10.1200/jco.2008.17.2775] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare malignancy in which patients have poor overall 5-year survival. Patients with ACC can present with symptoms of hormone excess, including Cushing's syndrome, virilization, feminization, or--less frequently--hypertension with hypokalemia. In many patients with ACC, advanced disease at presentation precludes surgery or is followed by local relapse or distant metastatic disease that cannot be managed surgically. In these instances, chemotherapy is often tried, but its limited efficacy all too often leaves the problem of persistent hormonal excess. Physicians who treat patients with ACC and severe hypercortisolism should recognize that uncontrolled hormone production is a malignant disease, which has severe consequences that require aggressive management. Because chemotherapy benefits only a small percentage of patients, steroidogenesis inhibitors, including mitotane, ketoconazole, metyrapone, and etomidate, should be used singly or in combination even as chemotherapy is administered. Diligent management with frequent adjustments is required, especially in patients with chemotherapy-refractory tumors that continue to grow. In the absence of randomized, controlled trials, adjuvant use of mitotane remains controversial, although the authors of a recent case-control study argue for its use. Despite difficulty administering effective doses, most clinicians agree that mitotane should be used if the tumor cannot be removed surgically or should be used as adjuvant therapy if there is a high likelihood of recurrence. The option of long-term monotherapy is restricted to patients who tolerate mitotane and either experience a clinical response or are at high risk for recurrence. Recommendations are provided to help manage patients with this difficult disease and to improve the quality of their lives.
Collapse
Affiliation(s)
- Irina Veytsman
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bldg 10, Rm 12N226, 9000 Rockville Pike, Bethesda, MD, USA
| | | | | |
Collapse
|
5
|
Abstract
Abstract
Analgesics are the most commonly consumed over-the-counter preparations in the United States. They are used in the treatment of various pain syndromes and other medical conditions. Although analgesics are generally perceived to be safe agents, serious toxicity may occur in the setting of acute overdose, chronic abuse, or overuse. The indications for therapeutic drug monitoring in patients using these medications appropriately is as yet not well defined. The emphasis of this discussion, therefore, is on recommendations for monitoring in situations where toxicity is suspected. Preanalytical, analytical, and practice issues including drug interactions, frequency of monitoring, pertinent ancillary tests, reporting, and special patient groups at risk for toxicity are reviewed. Recent information from a major manufacturer of evacuated tubes arguing against the use of gel tubes for blood collection for drug monitoring is included. Colorimetric/enzymatic/immunoassays for the routine/stat monitoring of acetaminophen and salicylate and diflunisal cross-reactivity with most of the currently used salicylate assays are presented. Achiral and chiral chromatographic assays and newly introduced columns such as restricted access media and/or automated chromatographic systems are reviewed for the analysis of ibuprofen, naproxen, and the recently introduced tramadol. Finally, concepts regarding future directions including drug chirality and chiral analysis are presented.
Collapse
Affiliation(s)
- Suzanne White
- Departments of Pediatrics and Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201
| | - Steven H Y Wong
- Department of Pathology, Medical College of Wisconsin and Milwaukee County Medical Examiner’s Office, Milwaukee, WI 53226
| |
Collapse
|