Psychopharmacology News and Views

I n this column I would like to make the readership aware of a number of interesting updates. The first has to do with antiepileptic agents that are frequently used in child and adolescent psychiatry even without Food and Drug Administration (FDA) approved indications. Back in January of 2008, the FDA issued a safety alert following a pooled analysis of controlled studies. It was determined that there was an increased risk of suicidal thoughts associated with 11 antiepileptic agents as compared to placebo. The analysis revealed that subjects who received the antiseizure medications developed suicidal behavior or ideation (0.43%) at twice the rate of those subjects who received placebo (0.22%). At that time, the FDA reported that these phenomena were noted as early as one week after initiating the medication and were noted to occur even at 24 weeks. In May of this year the FDA approved a labeling update to include increased suicide risk. Though the analysis included only 11 agents, the FDA believes the risk is carried by all medications in that class and will probably pursue a class labeling change for all the antiseizure agents. Of the 11 medications included in the pooled analysis, those most frequently used in our field include carbamazepine, gabapentin, lamotrigine, oxcarbazepine, topiramate and valproate. Practitioner's who prescribe these agents should monitor their patients closely for changes.

Another update is the addition of a boxed warning for metoclopramide. Apparently, the administration of this agent poses an increased risk for developing tardive dyskinesia when the agent is employed chronically or at elevated doses. Metoclopramide stimulates upper gastrointestinal motility and is used for gastroesophageal reflux among other things.

Our third update is to alert readers that there have been reports of patients who have suffered burns during magnetic resonance imaging (MRI) in the immediate area where medicated patches with metallic backings are placed. There are numerous over-the-counter agents and certain nicotine patches that employ metallic backings. Apparently, the backings are not ferromagnetic, and are not magnetically affected by the MRI machine, but the metal does conduct heat, which leads to the burns.

The final update really has no direct applicability to most patients we treat, but I wanted to share it as it does represent the evolution of pharmacology and the promise of a technologic approach that may benefit our field in the future. ATryn is the first biological product made from genetically engineered animals and was recently approved by the FDA. The agent prevents blood clots in a rare condition called hereditary antithrombin deficiency. The product is a protein that comes from the milk of genetically engineered goats that have had a DNA segment introduced into their genes. As a result the goats produce milk that contains human antithrombin.

We are including an upcoming conference for your consideration.

The 56th Annual Meeting of the American Academy of Child and Adolescent Psychiatry will be held in Honolulu, Hawaii from October 27 to November 1, 2009, contact (202)966–7300.