Medication Carlat Reports | Carlat Publishing

Research Update

Does Pioglitazone Lead to Reduced Alcohol Use?

From The Carlat Addiction Treatment Report, Personality Disorders and Addiction

Topics: Alcohol use disorder | Medication

REVIEW OF: Dieperink E et al, Am J Addict 2021;30(6):570–577 STUDY TYPE: Retrospective cohort study Some preclinical data suggest that pioglitazone (Actos), a medication commonly prescribed for type 2 diabetes, might be helpful for the treatment of addictive disorders, including alcohol use disorder (AUD). The purported mechanism is peroxisome p

Clinical Update

Prescribing to Children of Divorce

From The Carlat Child Psychiatry Report, Clinical Complexity With Children and Adolescents

Each year in the US, there are about 1.04 million divorces, affecting about 800,000 children. Beyond that, 1.9 million cohabiting (and unmarried) couples break up each year, of whom 60% have children (www.census.gov/data/developers/data-sets/acs-1year.html). It may not be the divorce itself that is hard on children, but how the divorce is handled (ie, a

Expert Q&A

Reduced Life Expectancy in ADHD

From The Carlat Child Psychiatry Report, ADHD in Children and Adolescents

CCPR: To start, tell us about how the thinking has changed in terms of health consequences from ADHD. Dr. Barkley: In the 1970s, we saw ADHD as an educational disorder with impacts on school behavior and academic achievement. Around that same time, there was a parallel path recognizing ADHD as a social problem in family functioning and peer relationshi

Research Update

Can Stimulants Prevent Crime?

From The Carlat Child Psychiatry Report, ADHD in Children and Adolescents

Review of: Mohr-Jensen C et al, J Am Acad Child Adolesc Psychiatry 2019;58(4):443–452 ADHD has long been linked to antisocial behavior leading to arrests and incarcerations. Children and young adults with ADHD are more likely to be charged with anything from traffic violations to violent crimes. However, these associations do not prove causality. I

Research Update

Methylphenidate Max Dosing

From The Carlat Child Psychiatry Report, ADHD in Children and Adolescents

Review of: Ching C et al, JAMA Pediatr 2019;173(7):630–639 Methylphenidate was one of the first stimulants prescribed for the treatment of ADHD in children, adolescents, and adults. Its efficacy is clear, and its availability in immediate release, sustained release, osmotic release oral system (OROS, brand name Concerta), and transdermal patch keep

Research Update

Prescribing Patterns for Children With Anxiety Disorders

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

Review of: Bushnell GA et al, J Clin Psychiatry 2018;79(1):pii:16m11415 Anxiety disorders are some of the most common conditions we encounter in children and adolescents, and clinicians employ a variety of medications to treat them. This study examined prescribing patterns for the initial treatment of pediatric anxiety. Researchers analyzed a larg

Research Update

Risk of Psychosis With Stimulants in ADHD Patients

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

Review of: Moran LV et al, N Engl J Med 2019;380(12):1128–1138 In 2007, the FDA required stimulant manufacturers to warn of possible psychosis with stimulants. But what is the real incidence? This study set out to find and discern if there is a difference between methylphenidate and amphetamine classes of medications. Drawing from two large comm

Clinical Update

PrEP: Introduction to the Basics

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Great strides have been made in HIV treatment and prevention during the last 2 decades, resulting in falling numbers of new HIV infections during that time span. But since 2013, the rate of new infections has mostly plateaued at just under 40,000 new infections per year (www.hiv.gov). Those at highest risk of infection remain men who have sex with men,

Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

Research Update

Varenicline and Bupropion: Soaring Again With EAGLES?

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Topics: | | | | | | | | | | | | | | | | | | | | Addiction Addiction Treatment Bupropion Chantix Co-occurring disorders Dual diagnosis FDA Warnings Medication Pharmacology Research Research Update Side Effects Smoking Cessation Smoking Cessation Agents Substance Use Substance use disorders Suicidality Suicide Tobacco Varenicline Wellbutrin

Review of: Anthenelli RM et al, Lancet 2016;387(10037):2507–2520 Varenicline (Chantix) and bupropion (Zyban and others) are effective treatments for tobacco use disorder, but their use (and sales) took a big hit in 2009 when the FDA slapped both with black box warnings linking them to psychiatric complications, including suicidal ideation. Although

Research Update

The COMBINE Study: A Core Paper in the Treatment of AUD

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Clinical Update

Medications for Alcohol Use Disorder: An Overview

From The Carlat Addiction Treatment Report, Alcohol Use Disorder

Topics: Alcohol use disorder | Medication | Psychopharmacology

Alcohol use disorder (AUD) is the most common substance use disorder by far, with a lifetime prevalence of nearly 30%. It is also vastly undertreated; less than 20% of people with AUD ever receive treatment (Grant BF et al, JAMA Psychiatry 2015;72(8):757–766). To make matters worse, there are only three FDA-approved medications for AUD: disulfiram, ac

Expert Q&A

Alternative Therapies for SUDs

From The Carlat Addiction Treatment Report, Alternative Treatment in Addiction

CATR: Please tell us about your work. Dr. Novella: As an academic neurologist at Yale, I spend most of my time seeing patients, usually in the context of teaching students, residents, fellows, etc, and I do some clinical research. I also run the site Science-Based Medicine (www.sciencebasedmedicine.org), which promotes high standards of science through

Clinical Update

“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

With other epidemics in the world dominating our attention, let’s not forget the epidemic of opioid-related deaths. Unlike the current viral epidemic, the opioid epidemic is eminently treatable. The figure on page 3 shows the reduction in heroin overdoses in Baltimore, MD, as increasing numbers of patients received opioid agonist treatment (Schwartz R

Clinical Update

Updated Guidelines for Treating Opioid Use Disorder

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

Expert Q&A

Treating Alcohol Use Disorder

From The Carlat Addiction Treatment Report, Alcohol Addiction

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

News of Note

New Generic Versions of Naloxone

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Naloxone, a rescue medication effective for reversing opioid overdoses, will soon be available in two generic forms for layperson use. Naloxone nasal spray is the generic version of branded Narcan Nasal, which currently sells for $150 for two doses. The generic version will be much cheaper. Naloxone auto-injector is the generic version of Evzio au

Research Update

Gabapentin Enacarbil XR Efficacy Less Than Expected for AUD

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Falk DE et al, Alcohol Clin Exp Res 2019;43(1):158–169 Gabapentin enacarbil extended-release (GE-XR) (Horizant) is an extended-release version of gabapentin. GE-XR is a prodrug, meaning that once ingested it is metabolized into gabapentin. It is currently approved for treatment of postherpetic neuralgia and restless legs syndrome. It di

Research Update

Can Buprenorphine Improve PTSD Symptoms?

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal

Clinical Update

Buspirone: Still Effective After All These Years?

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

When buspirone was released in 1986, it was advertised as providing “a different kind of calm.” Unfortunately, physicians and their patients weren’t ready to accept the kind of calm that required several weeks to take effect, when punchier, quicker benzos were the standard route to tranquility. Although buspirone is FDA approved for generalized an