Disclaimer: This is not an all-encompassing list of news updates from the months of January to March 2023. 

As we enter the first quarter of 2023, the world continues to experience a wide range of significant events and developments that are already shaping our future in significant ways. From political upheavals and global health crises to breakthroughs in science and technology, the first three months of 2023 have been marked by numerous significant stories. With the continued spread of the COVID-19 pandemic, the emergence of new geopolitical tensions, and the rapid pace of technological change, the top news stories of the first three months of 2023 are already setting the stage for a year that promises to be both eventful and impactful.

Here is a look at some of the top medical news of 2023 so far. 

Weight loss drug for kids

Courtesy of Ascend Medical

In early January, the American Academy of Pediatrics (AAP) updated their guidelines to include certain medications be used in children 12 years and above for weight loss. This is different from the past recommendations because now there is more focus on treating obesity as opposed to preventing it in children. 

In the United States, 1 in 5 (over 14 million) children and adolescents are affected by obesity. Current medications that are recommended for weight loss in children are: 

• Metformin
• Orlistat
• GLP-1 agonist: Wegovy and Saxenda 
• Phentermine/Topiramate (Qsymia) 
• Vyvanse 

Weight Loss Drugs for Kids

FDA Approves New Weight Management Drug for Kids over 12

U.S. experts recommend weight-loss drugs for obese children

Vaccine for Bees 

Courtesy of CNN

The US Department of Agriculture (USDA) in January approved the world’s first vaccine for bees to protect them against American foulbrood, an aggressive bacterium that can spread quickly from hive to hive. Previously, either burning infected colonies and all associated equipment or using antibiotics were the only ways to treat the bacteria. The particular bacteria, Paenibacillus larvae, causes the American foulbrood which results in the larvae becoming brown goo with a rancid stench. 

How does the vaccine work? 

The vaccine is mixed with food that the worker bees will eat. They then will secrete their milky royal jelly, that contains the vaccine, to the queen for her to ingest. The vaccine will then travel to her ovaries which will immunize developing larvae. Research has shown no negative effects on queens’ survival or honey quality. At this time, due to conditional licensing from the USDA, the vaccine is only available for commercial beekeepers. 

This advancement in vaccine development can avoid costly treatment of infections in hives and point more attention to other ways to keep bees healthy and high quality honey. 

U.S.D.A Approves First Vaccine for Honeybees

The World’s First Vaccine for Honey Bees is Here 

Dalan Animal Health

Atypical Anorexia 

Courtesy of Center of Discovery

Atypical anorexia (AAN) is a type of eating disorder that shares many of the same symptoms as anorexia nervosa, but with one key difference: individuals with atypical anorexia may not have a low body weight or be underweight. Despite not meeting the traditional diagnostic criteria for anorexia nervosa, individuals with atypical anorexia still struggle with restrictive eating patterns, an intense fear of gaining weight, and a distorted body image. AAN is just as serious as anorexia nervosa and can lead to significant health complications if left untreated, including malnutrition, dehydration, and organ damage. Currently, there has been an increasing number of children and adolescents presenting with AAN. Treatment for atypical anorexia typically involves a combination of therapy, nutritional counseling, and medical monitoring to help individuals overcome their disordered eating patterns and improve their overall physical and mental well-being.

What is Atypical Anorexia Nervosa: Symptoms, Causes and Treatment

Child Mind Institute: What is Atypical Anorexia Nervosa? 

Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap

The Push for Fentanyl Testing

Courtesy of CNN

The CDC has indicated that more than 250 Americans are dying each day from overdosing. Josh Siems, a Baltimore native, died from a fentanyl overdose in 2022 which prompted his family to push lawmakers to pass a law requiring emergency rooms to test for fentanyl in their toxicology report in the state of Maryland. Currently only 5% of overdose patients get tested for fentanyl in the United States. 

Hospitals are increasingly pushing for fentanyl testing as part of their efforts to combat the opioid epidemic. Fentanyl is a synthetic opioid that is up to 100 times more potent than morphine, and its use has been linked to a sharp rise in opioid-related deaths in recent years. By testing for fentanyl in patients, hospitals can identify individuals who may be at risk for overdose and provide them with appropriate interventions, such as medication-assisted treatment or naloxone administration. Fentanyl testing can also help healthcare providers to better understand the scope of the opioid crisis and to track trends in drug use and abuse. However, there are some challenges associated with fentanyl testing, including the need for specialized equipment and training, as well as concerns about patient privacy and confidentiality. Despite these challenges, many hospitals are prioritizing fentanyl testing as a key component of their efforts to address the opioid epidemic and improve patient outcomes.

Fighting Fentanyl: The Federal Response to a Growing Crisis

Fentanyl death prompts push for more testing-The Baltimore Banner 

Only 5% of Overdose Patients Tested for Fentanyl, #1 Killer of Americans 18-45

Covid-19 Update 

Courtesy of FDA

As of March 2023, the COVID-19 pandemic is still ongoing but the situation has significantly improved compared to the early stages of the pandemic. Vaccines have played a key role in controlling the spread of the virus, with at least 270 million Americans having received at least one dose of a COVID-19 vaccine. 

There have been some promising developments in COVID-19 treatment, including the use of monoclonal antibodies, antivirals, and other therapies. However, access to these treatments remains limited in some parts of the world. Additionally, there is still a need for continued research into the long-term impacts of COVID-19 on health and wellbeing.

Overall, while there have been some positive developments in the fight against COVID-19, it is clear that the pandemic will continue to have far-reaching effects for years to come. Ongoing efforts are needed to ensure that vaccines, treatments, and other resources are equitably distributed to all parts of the world, and that we continue to work together as a global community to address the ongoing challenges of COVID-19.

Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap 

FDA Approves First Over the Counter Naloxone Nasal Spray 

Courtesy of narcan.com

On March 29, 2023 the FDA approved Narcan, 4mg naloxone nasal spray for over the counter (OTC) use to reverse opioid overdose. Drug overdose is a persistent issue in the United States as there were over 100,000 reported fatal overdoses occuring in a 12-month period ending in October 2022. 

Manufacturers will be required to submit changes in labeling which includes providing proof of effectiveness and safety for switching to OTC. The FDA will work with stakeholders to facilitate the availability of naloxone nasal spray to ensure they will be able to be sold in places directly to consumers, such as drug stores, convenience stores, grocery stores, gas stations and online as well. The idea of making Narcan available without a prescription is huge because this move would enable more people to have access to the lifesaving drug, especially in areas where opioid overdose is prevalent. 

FDA Approves First Over-the-Counter Naloxone Nasal Spray

DISCLAIMER: This article is provided as commentary and discussion, not direct medical advice. Before making any medical decision, consult with your medical provider.  

Pharmacists are often consulted for recommendations regarding patient allergies by other health care professionals. One such allergy that is frequently reported by patients is an allergy to an opioid. Sometimes patient-specific reactions are reported in an electronic medical record (EMR), but other times reactions are unknown.

This begs an important question – what can be done for patients who have listed allergies to an opioid? How can a clinician navigate this situation and what do patients need to know?

To address these thoughts, it is important to understand some background about opioids and their associated allergies.

Opioids are usually categorized by both chemical synthesis (the process of creating chemical compounds) and chemical structure.

Morphine’s chemical structure is the basis for most other opioids and it is considered to be a ‘pure opiate’. Pure opiates can be derived directly from the opium poppy plant. Semi-synthetic compounds such as hydrocodone, oxycodone, and hydromorphone are produced by making modifications to pure opiates. Then, there are fully synthetic compounds such as fentanyl, tramadol, and methadone that share less structural similarities compared to pure opiates and semi-synthetics; they are also not produced using naturally-occurring opioids (Table 1). 

However, this is not a complete picture. Despite being semi-synthetic, many opioids still share common structures with morphine. A more exact breakdown of opioid structures is demonstrated in Table 2 for reference.¹

Table 1. Classes of Opioids by Chemical Synthesis²

Table 2. Classes of Opioids by Chemical Structure

*Phenanthrenes lacking a 6-OH group have potentially decreased cross-reactivity compared to morphine and codeine

Unfortunately, the terminology here is inherently technical, but focus less on the terms and more so on the association. Within Table 1, all the semi-synthetic opioids in Group 2 are phenanthrenes that lack a 6-OH group within their chemical structure. When looking at Group 3, all are non-phenanthrene structures. This will be important when discussing trialing opioids in patients with listed allergies.

Pure opiates, semi-synthetics, and synthetics all have side effects common to all opioids (e.g. respiratory depression, sedation, nausea, constipation). However, opioids tend to cause reactions that many patients mistakenly associate as an allergy. Opioids can cause the release of histamine which can cause reddening of the skin, sweating, itching, hives, and/or mild hypotension (low blood pressure).  This is commonly called a pseudo-allergy and is most common with pure opiates like morphine and codeine.

Listed reactions such as nausea, constipation, and stomach upset are actually common side effects of opioids; not an allergy. Reactions like hives, redness, itching, and sweating are likely pseudo-allergies. These reactions are not life-threatening and are fairly common.

In fact, allergies to opioids are some of the most commonly listed allergies in hospitalized patients’ medical records – even more so than antibiotics (Table 3). Much like reported penicillin allergies, most of these allergies are not necessarily immune-related and do not require complete avoidance by a medical team. 

Table 3. Frequency of Drug Allergy Alerts (Adapted from data published by Topaz M, et al. 2015)³

NSAID: non-steroidal anti-inflammatory drug

With this in mind, we know that listed allergies to opioids are common. However, for patients with unknown reactions, how common are severe reactions to opioids such as swelling of the lips/tongue or anaphylaxis?

Because humans produce opioid peptide substances (e.g. endorphins and enkephalins) naturally, the likelihood that a patient would have an anaphylactic response to an opioid provided in a medication would seem low. The data appear to validate this sentiment, too.

A review (study) of opioid chart allergies and subsequent opioid administration demonstrated that the rate of an immune-mediated reaction was low (1.6%) and was not significantly different between classes of opioids. 92.5% of patients in the study tolerated receiving another opioid. Of the 461 patients who tolerated administration of an opioid in this review, only one had a possible anaphylactic reaction. This patient continued to receive subsequent doses of the medication that caused the allergic reaction without issue.⁴

The same study found that out of 789 patients with a listed opioid allergy, only 2 had a possible anaphylactic reaction. In a survey of clinicians regarding opioid allergies (over 50% were pharmacists), 44 out of 54 (81.5%) had not seen an anaphylactic event associated with opioids in their career.⁴ From what this data shows, the likelihood that a patient would have a severe allergy to an opioid appears very low, and this is from a population of patients a listed history of immune-mediated reactions. In a more general population with non-severe listed allergies, this rate would likely be even lower. This is important to keep in mind when attempting to evaluate listed allergies with unknown reactions and lacking a way to validate or confirm the reaction.

Despite the rarity of a severe allergy, when asked about giving a patient an opioid with an unknown reaction listed, fewer than 15% of clinicians were willing to give the patient the same opioid.⁴ This is understandable, but this question only addressed giving the same opioid; not a similar alternative. Additionally, it reinforces the fact that gathering a thorough history of the allergy is imperative for making a sound clinical decision.

For most patients, giving an opioid in a different clinical class (pure opiate, semi-synthetic, synthetic) appears to be a safe option (see the data from the retrospective review). For those patients with an unknown reaction, healthcare professionals need to attempt to gather more information about the allergy. This may be done by directly communicating with the patient or by looking through their medical history. Reviewing the medications a patient received during a prior visit to the hospital can be very helpful and provide additional context prior to discussing the allergy with the patient.

For comparison, in patients with listed penicillin allergies, seeing that they received repeated doses of antibiotics similar to penicillin like piperacillin/tazobactam (Zosyn) or ceftriaxone (Rocephin) during prior visits suggests the allergy is non-severe and is tolerable. Many times, the allergy is never corrected despite tolerating therapy. The same thought process applies with opioid allergies. If a patient had a prior surgery or hospitalization of any kind, then they could have received an opioid. If they did, then the potential severity of that allergy likely decreased significantly.

If the allergy cannot be clarified, then the use of another opioid should be considered on a risk/benefit basis and using clinical judgement. But before a healthcare professional chooses an opioid, it is important to consider whether an opioid is even necessary for the treatment of the patient’s pain.

An opioid is not always necessary. Most patients without liver dysfunction should have scheduled or as-needed acetaminophen (Tylenol) provided for baseline pain control. Similarly, for most patients without kidney dysfunction or significant heart disease, non-steroidal anti-inflammatory drugs (NSAIDs) can be added for further pain control. Ibuprofen (Advil) and naproxen (Aleve) are examples of NSAID drugs. There are also compelling indications for non-opioid therapies in certain situations (Table 4). Depending on the exact type of pain, therapies like nerve blocks can also be utilized, but these come with their own risks.

Table 4. Opioid Alternatives by Indication*

*Support for these treatment options varies in the literature. Often, these agents are assessed as adjuncts to opioids and not as complete alternatives; IV = intravenous

If an opioid is still required for pain control and opioid alternatives cannot be utilized, then synthetic opioids can be considered. Synthetic opioids theoretically have the lowest risk of cross-reactivity when compared to semi-synthetics and pure opiates and this has been demonstrated in some case studies.^1,5

However, these agents do have some unique extra considerations worth evaluating.

Tramadol, a commonly prescribed synthetic opioid, may be an effective agent for treating milder pain but it comes with the risk of serotonin syndrome, and it may not be an ideal drug for patients taking multiple serotonergic medications (medications that affect serotonin levels in the body). Additionally, it should be avoided in patients with a history of seizures or diagnosis of epilepsy.

Methadone is long-acting synthetic opioid and comes with the risk of QT prolongation. Additionally, its long and variable half-life (duration of effect) makes it difficult to quickly titrate to the patient’s acute pain.

FAST FACT: QT prolongation, also called long QT syndrome, is a medical condition that can cause the heart to take longer to rebound after each beat. QT prolongation may lead to dizziness, fainting, heart palpitations (fast/unpredictable heart beat), seizures, etc. If left untreated, it may lead to death in certain cases.

Meperidine, another synthetic opioid, is not recommended for use for greater than 48 hours due to its toxic metabolite, nor-meperidine, and therefore is mostly relegated for the treatment of post-operative shivering (rigors).

In IV formulation, fentanyl is likely best suited for critical care settings where its potency and quick onset of action is beneficial for treating severe acute pain. It is also used as an adjunct therapy option for sedation. As a patch, fentanyl is indicated only for opioid-tolerant individuals (individuals who have been previously given an opioid), which would likely not be the case for a patient with a listed opioid allergy.

If a patient has a non-severe allergy to morphine, then substituting for a semi-synthetic or synthetic opioid would be reasonable. A trial of a semi-synthetic is likely preferred because synthetic agents are typically either 1) very potent or 2) have extended adverse effect profiles. Consider utilizing antihistamines to improve tolerability; but do keep in mind the increased sedation that may occur when co-administering diphenhydramine (Benadryl).

For patients with a severe allergy (e.g. swelling of the lips/tongue, anaphylaxis) to a pure opiate, the conservative route for managing these patients would be to utilize a synthetic opioid. Semi-synthetic opioids should not be used if a patient has a true anaphylactic allergy to morphine. If a semi-synthetic opioid is used, then increased monitoring would be appropriate to quickly respond to any adverse reaction. The risk of cross-reactivity appears low, but it is not zero. If a decision is made to give a semi-synthetic opioid, it is important that the patient’s nurse and other integral members of the patient’s care are aware of the decision.

Summary

Unfortunately, there is limited literature/data available regarding opioid allergies, and treatment decisions made by healthcare professionals are mostly guided by clinical experience and judgement. Despite these limitations, utilizing the data that is available and what is known about the chemical structures of opioids can assist in making an educated decision.

Additionally, for tricky opioid allergy situations, consultation of the pain management service should be considered if one is available. They likely have experience with these situations and since much is guided by clinical judgment their input would be valuable.

Allergies are an important and powerful piece of medical information. They directly impact medical decision-making, regardless of their accuracy. Sometimes this can lead to more expensive care, delays in care, and potentially sub-optimal care. This makes the verification of these allergies a very important process.

When confronted with an opioid allergy, before considering alternative opioids, the patient should be asked about their reaction. This is a key piece of information that is often missed in the collection of allergy information. A conversation should be had regarding the patient and provider’s willingness to retry the medication or a similar one – any medication choice should be a shared decision between the patient and provider whenever possible. As a patient, it is essential to inform a healthcare team everything that is known about a potential opioid allergy so an informed treatment decision can be made from all perspectives. Providers must always weigh the risks and benefits of treatment.

In the case of opioid allergies, it appears that the vast majority of listed allergies are actually just side effects or intolerances to the medication. Rarely is this allergy truly anaphylactic, but this is no reason not to exercise caution for patients with unknown reactions. Extra attention and monitoring may be warranted to ensure no harm is done.

References: 

1. Li PH, Ue KL, Wagner A, Rutkowski R, Rutkowsi K. Opioid hypersensitivity: predictors of allergy and role of drug provocation testing. J Allergy Clin Immunol Pract. 2017;5(6):1601-6.
2. Hayes B. UMEM Educational Pearls – Opioid Allergies and Cross Reactivity. University of Maryland Department of Emergency Medicine. Updated 21 March 2021. Accessed 21 March 2021. Accessible via: https://umem.org/educational_pearls/578/ 
3. Topaz M, Seger DL, Slight SP, et al. Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience. J Am Med Inform Assoc. 2016;23(3):601-8.
4. Powell MZ, Mueller SW, Reynolds PM. Assessment of opioid cross-reactivity and provider perceptions in hospitalized patients with reported opioid allergies. Ann Pharmacother. 2019;53(11):1111-23.
5. Kalangara J, Potru S, Kuruvilla M. Clinical manifestations and diagnostic evaluation of opioid allergy labels – a review. J Pain Palliat Care Pharmacother. 2019;33(3-4):131-140.

To say the least, COVID-19 has dominated news headlines for the past few weeks. This trend will only continue for the foreseeable future. 

As world citizens are increasingly being told to stay at home, a sweeping amount of time is collectively being spent online surveying the COVID-19 landscape. Thus, this article identifies trustworthy websites to bookmark and access going forward for credible coronavirus-related information. 

DEFINITION: COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Emerging as a threat in the latter part of 2019, the World Health Organization (WHO) officially labeled COVID-19 as a pandemic on March 11^th, 2020. 

Due to the rapidly-changing nature of the pandemic, Pharmacist Consult is not in a position to provide any additional medical advice related to COVID-19 aside from listing out appropriate resources to learn from. It is important to be vigilant with staying up-to-date via the resources mentioned below.

1. Centers for Disease Control and Prevention (CDC)

This resource is arguably the most advertised place to access COVID-19 information, and for good reason. The CDC and the World Health Organization (WHO) are the most trusted organizations to learn from regarding protective measures, what to do if questionable symptoms start to appear, and they detail essential pathology aspects of the novel coronavirus.

The CDC also has a running list of the number of confirmed coronavirus cases in the United States. Similarly, the CDC provides an essential 1-page fact sheet to be aware of for readers who simply want a quick summary of what to know. 

Out of all of the websites on this list, the CDC’s website is the one that readers should place the biggest emphasis on exploring and getting familiar with. 

2. COVID-19 Disease Tracking Map (New York Times)

The New York Times has a dynamic and resourceful map that tracks the number of confirmed coronavirus cases and where they are located. This map offers an illustration of this on a continent-by-continent basis. Also, it offers a state-by-state breakdown for the United States to see where current disease hotspots are. 

3. Comprehensive Rolling Updates (WHO)

Alongside the CDC, the WHO is one of the best organizations to use for COVID-19 information. Although their general coronavirus website as a whole is useful, their chronological list of events related to the COVID-19 pandemic is thorough and it provides a productive method to see how the global situation has developed over time.

Their chronological account begins on December 31st, 2019 and it has been updated multiple times per week since then with important developments.

4. State-by-State COVID-19 Resources

It is important to stay updated about the disease from international and national points-of-view. Respectively, utilizing the WHO and CDC as primary resources are optimal ways to stay informed on these levels. 

However, for readers in the United States, it is also important for state residents to stay current with their state’s response(s) to COVID-19. Those responses are linked to state government resources listed below. 

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

5. Travel Recommendations By Country (CDC)

Individuals are being told to stay home, and in an increasing number of situations, individuals are being forced to stay home. Borders are being closed, flights are being canceled, and the overall movement of people is decreasing significantly. This is having profound repercussions on domestic and international travel alike. 

This resource from the CDC is a tool to utilize for making informed travel decisions during the COVID-19 pandemic. To utilize this resource most optimally, an important prerequisite is to first be aware of the different travel notice levels and what they mean. 

A Level 1 notice urges travelers to heed caution and to travel with normal, standard precautions. A Level 2 notice warns travelers to be especially alert and to practice enhanced precautions. A Level 3 notice is a not-so-subtle warning that specifies the need to avoid non-essential travel. 

6. Information for Employers and Workers (OSHA)

Seemingly all non-essential employees are being told to stay home during the current pandemic. However, there are still a significant number of individuals who must physically report to work every day. This page from the Occupational Safety and Health Administration (OSHA) provides essential information for both employers and workers.

This page from OSHA details hazard recognition, standard measures to protect workers during the COVID-19 pandemic, necessary medical procedures to protect workers, and actions that employers can take to help with the control and prevention of further viral spread.

7. Separating Fact from Fiction (Multiple)

There are a handful of reputable organizations that have dissected false myths about COVID-19. A few of the more helpful breakdowns are described here. 

The WHO is inherently a go-to COVID-19 resource, and their dissection of false claims comes complete with graphics. Johns Hopkins Medicine is one of the most highly-esteemed medical institutions in the United States, and they provide a similar list of COVID-19 FAQ’s. To test how much you’ve absorbed, UNICEF has a quiz to gauge readers’ knowledge about COVID-19. 

8. COVID-19 Resource Center (The Lancet)

The Lancet is a peer-reviewed medical journal. It is one of the world’s oldest and most prestigious medical journals available. The Lancet also has a number of different specialty journal subsidiaries such as The Lancet Respiratory Medicine, The Lancet Gastroenterology & Hepatology, The Lancet Infectious Diseases, and numerous others. 

Public health and medical advances relating to halting the progression of COVID-19 are rooted in scientific studies and medical breakthroughs. These types of studies and breakthroughs are published in peer-reviewed journals like The Lancet. 

For individuals who are curious about accessing recent publications related to COVID-19, this resource compiles all COVID-19 publications produced by The Lancet and its subsidiary journals into one location. All COVID-19 content published by The Lancet is free to access. 

Resources:

Autism, or Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder that affects social communication, interaction, behaviors and interests. It is characterized by a range of symptoms and severity, which is why it is called a spectrum disorder. Symptoms typically appear in early childhood and can include difficulties with communication, social interactions, repetitive behaviors, and sensory sensitivities. Autism can have a significant impact on a person’s daily life, and it is estimated that approximately 1 in 36 children in the United States are diagnosed with ASD today. Despite ongoing research efforts, the exact causes of autism are still not fully understood, and there is currently no known cure. However, early diagnosis and intervention can greatly improve outcomes for individuals with autism.

What are Current Therapies for ASD? 

At present, there is no single drug that has been specifically approved for the treatment of ASD. However, there is an array of medications and treatment options that may be used to address certain symptoms associated with ASD, such as anxiety, aggression, hyperactivity, attention problems and irritability. 

Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics may be prescribed to treat anxiety and aggression. Other medications, such as stimulants and alpha-agonists (clonidine and guanfacine), may be used to address hyperactivity and inattention. Probiotics have been shown to potentially improve symptoms of autism. Additionally, there have even been studies showing cannabidiol (CBD) as a potential treatment in reducing anxiety for ASD.

However, people with ASD are referred to specialists that provide behavioral, psychological, educational and skill-building interventions to help them cope and manage the symptoms. In any case, it is important to note that there is no one-size-fits-all approach to treating ASD, and the most effective treatment plan will depend on the individual’s specific needs and symptoms. 

What is the Potential “Cure” for Autism? 

MYT1L is a gene that is expressed in all neurons throughout life. Recently the discovery of its mutation have been reported in patients with intellectual disability, schizophrenia, epilepsy, and even ASD. Besides behavioral factors, people with MYT1L mutations may display developmental delays, obesity, seizures, and brain malformations. 

The science behind this mechanism stems from the neuronal deficiency in the MYT1L gene that can cause electrophysical hyperactivity which is also seen in people with seizures, but can also show the typical symptoms and functional changes of autism. The recent study has shown lamotrigine, a medication used to treat epilepsy may have the potential to help treat autism. ASD is not only about impairments in social interactions, communication, stereotypical behavior patterns, but epilepsy and hyperactivity can also be seen. 

Image courtesy of genecards.org

So far this concept has only been studied in mice and no actual research in humans has been done to further understand the link of MYT1L gene mutation and autism and with the potential use of lamotrigine for treatment. Although this theory is in its early stages of discovery, the excitement of having another possible treatment for autism seems to be near. It might not be a total “cure” for this condition, but it does take a step in the right direction of being able to manage symptoms and give people with ASD the ability to form stronger connections with the world and shape their own future. 

References: Weigel, Bettina, et al. “MYT1L Haploinsufficiency in Human Neurons and Mice Causes Autism-Associated Phenotypes That Can Be Reversed by Genetic and Pharmacologic Intervention.” Molecular Psychiatry, 2023, https://doi.org/10.1038/s41380-023-01959-7.

Disclaimer: This does not include all recently approved or newly marketed medications.

As the world continues to face unprecedented health challenges, the pharmaceutical industry is working tirelessly to develop new drugs and treatments that can improve the quality of life for millions of people around the globe. In 2023, we can expect to and can currently see the release of several new drugs that have the potential to revolutionize the way we approach a range of illnesses and conditions. This article will explore some of the most exciting new drugs set to hit the market in the coming year, and what they could mean for patients and healthcare providers alike.

"Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided.” - Paracelsus

Migraines 

In 2019, there was a reported 1.1 billion cases of migraines with much more possibly being affected now more than ever. Migraines can significantly affect people’s quality of life, causing intense headaches, nausea, and sensitivity to light and sound. It affects both children and adults, with women being three times more likely to experience migraines than men. There are currently a plethora of medications on the market for migraines but since this is a very common condition, there are always new ones that sneak up in the market. Calcitonin gene-related peptide (CGRP) antagonists have dominated the headache market since its first approval medication in 2018 (Aimovig). Here are a couple more that you’ll see soon or might currently see on the shelves. 

Qulipta 

Zavzpret 

Psoriasis 

There are currently 125 million in the world that have psoriasis, with 30% of those also suffering with psoriatic arthritis. Psoriasis is a chronic autoimmune skin disease that speeds up growth of the cell cycle. It often manifests as patches of thick red skin and silvery scales on the elbows, knees and scalp but can also cover the entire skin. Psoriatic arthritis is an inflammation of the joints and has the same signs and symptoms as psoriasis. Psoriasis has a variety of different treatments, from light therapy and topical steroids to biologics both in oral and injectable administration forms. There are two new medications on the market, Vtama ® and Sotyktu ®. Vtama is the first ever cream of its kind that is non-steroidal and uses a aryl-hydrocarbon receptor agonist that downregulates pro-inflammatory markers and reduces inflammation. Sotyktu ® is the first oral medication in its class for psoriasis. 

Vtama (tapinrof) 

Sotyktu (deucravacitinib)

Diabetes 

Type 2 diabetes is a chronic metabolic disorder characterized by high blood glucose levels due to the body’s inability to use insulin effectively. This condition is a major global health concern, affecting millions of people worldwide. In fact, according to the World Health Organization (WHO), the prevalence of type 2 diabetes has been steadily increasing over the years and is expected to continue to rise in the future. Currently there are a variety of medications for Type 2 diabetes. Brenzavvy ® is a new medication in the class of SGLT2 inhibitors. 

Brenzavvy (bexagliflozin)

Alzheimer’s Disease 

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that affects the brain, leading to a decline in memory, thinking, and behavior. The disease is characterized by the buildup of abnormal proteins in the brain that cause damage to nerve cells, leading to their death. The prevalence of AD is increasing in America, with an estimated 6.7 million people ages 65 years and older currently living with the disease. As there is currently no cure for AD, early detection and management of symptoms are essential for improving the quality of life for those affected by the disease. Early this year, the FDA has approved Leqembi ®, a treatment for early AD, which may slow down cognitive decline in the early stages. 

Leqembi (lecanemab-irmb)

As of 2023, there have been numerous advancements in the development of novel drugs across various therapeutic areas. The pharmaceutical industry has continued to invest heavily in research and development, resulting in the approval of several innovative drugs with improved efficacy and safety profiles. With ongoing research and development, it is likely that we will continue to see advancements in the field of novel drugs in the years to come, providing patients with new treatment options and hope for better outcomes.

“Diabetes.” We hear this word and our minds automatically think “too much sugar and too much carbs”. But there is more to having diabetes and prediabetes than just eating excess amounts of sugar and carbs, there is also a component called insulin resistance that plays an important role in this condition. 

What is Insulin Resistance? 

Insulin is a hormone that is made by the pancreas and its role is to bring glucose (sugar) molecules into the cells for storage to then later be utilized for energy when needed. Our main sources of glucose are either obtained from foods that we consume or from the conversion from fats in the liver when we need energy, which causes a rise in blood glucose levels. This rise results in the pancreas releasing insulin into the blood which later lowers the levels in order to keep it in normal range. 

Insulin resistance occurs when the muscles, fat and liver cells do not respond well to insulin and cannot take up the glucose from the blood, therefore causing the pancreas to make more insulin in order to try to push it into the cells. The pancreas can sometimes produce enough insulin to overcome this resistance from the cells, therefore being able to keep levels in range. However, what happens when the pancreas isn’t able to meet the glucose demand anymore? 

What are the results of Insulin Resistance? 

When the pancreas gets to the point where it can no longer produce enough insulin to accommodate the rising levels of blood glucose, prediabetes is the first thing to occur. Prediabetes is defined as having higher than normal blood glucose level but not yet severe enough to be type 2 diabetes. It is estimated that 96 million American adults (more than 1 in 3) have prediabetes. And of this estimate, more than 80% probably do not even know that they have it. Those with prediabetes should take this seriously as they are at higher risk of developing type 2 diabetes, heart disease, strokes and more. 

What are the factors that contribute to insulin resistance? 

There are a variety of factors that can cause insulin resistance but the major factors are excess weight and physical inactivity. 

• Excess weight. Having excess fat especially around the abdomen and organs, also called visceral fat, can cause insulin resistance. Visceral fat can make hormones and other substances contribute to chronic inflammation in the body. Inflammation actually plays an important role in the development of insulin resistance, type 2 diabetes, heart disease and other chronic conditions. 
• Physical Inactivity. Not being physically active on a daily basis has been linked to numerous chronic conditions with insulin resistance and diabetes being the primary ones. 
• Other factors. 
  • Being 45 years or older
  • Having a close relative (parent, brother or sister) with type 2 diabetes 
  • Having gestational diabetes (diabetes during pregnancy) or giving birth to a baby weighing more than 9 pounds
  • Having polycystic ovary syndrome (POS)-common female infertility
  • Having African American, Hispanic/Latino American, American Indians and Pacific Islander background

How does obesity and chronic inflammation cause insulin resistance? 

Inflammation is the body’s way of defending against infections, injuries, and toxins in order to heal itself. However, chaos can happen when our defense system works a little too well and has to work overtime. This leads to chronic inflammation which can wreak havoc on many organs of our body, especially ones that contribute to insulin resistance. 

There is no question that obesity is becoming a major issue in today’s society with it being linked to a variety of chronic conditions, such as, diabetes, heart disease and even certain cancers. The proposed mechanism behind obesity causing inflammation is that the adipose tissues (or fat cells) produce a higher than normal amount of immune cells and defense markers which impair insulin communication and therefore helps to further promote insulin resistance. 

How can you tell if you have insulin resistance or prediabetes? 

Typically there are no major signs or symptoms if someone has insulin resistance or prediabetes. However, some people may present with darkened skin surrounding the armpits or on the back and sides of the neck which is called acanthosis nigricans. Sometimes, people may complain of excess thirst, hunger and urination and will have low energy. But the only way to be certain if someone has prediabetes is to take a blood test to measure both hemoglobin A1C (measures the percentage of glucose molecules on blood cells over the past 3 months) and fasting plasma (or blood) glucose levels. A1C and fasting blood levels for prediabetes will result in 5.7 to 6.4% and 100 to 125 mg/dL, respectively. Anything beyond these levels is indicative of type 2 diabetes and in this case, treatment will need to be started. 

Insulin resistance is typically not measured in normal blood panels and is also a bit more complicated. It is best to incorporate several factors in determining if insulin resistance is present. High fasting insulin levels are strong indicators of insulin resistance along with high blood triglycerides, low HDL (good) cholesterol levels and excess belly fat. 

Is Insulin Resistance reversible? 

The good news about insulin resistance and prediabetes is that they can be reversed. This can be achieved mainly by ensuring that blood glucose levels are within normal range and the pancreas is not having to work overtime to produce high amounts of insulin. One major change that can lower insulin resistance is by getting more physical activity. Exercise can actually make cells more sensitive to insulin which will lower blood glucose levels. This in turn will also help to lose excess fat and weight which will reduce the chances of developing diabetes and other chronic conditions. Aim for at least 30 minutes a day for at least 5 days a week.

Although physical activity is important, another major change that will be needed to reverse insulin resistance and prediabetes is through diet modifications. Some tips on how incorporate this into your normal routine are: 

• Cutting out processed foods and drinks that contain refined sugars and carbohydrates, such as cookies, cakes, chips, sodas and juices. (Specifically try to stay away from white refined sugars and carbohydrates such as white rice, pastas and bread). 
• Eating more non-starch vegetables, such as dark green leafy vegetables.
• Eating more foods rich in fiber: almonds, black beans and oatmeal.
• Eating more lean proteins: chicken, turkey, fish and low fat diary.

Taking a medication called metformin, typically used in patients with type 2 diabetes, is also another way to help lower insulin resistance and delay diabetes. However, if patients want to actually reverse diabetes, they must also incorporate a healthy diet and physical activity to their daily routine while taking this medication. 

Overall insulin resistance might seem like just a mere warning but can lead to a myriad of problems if not promptly corrected. Type 2 diabetes is not the only issue that can occur with insulin resistance. Heart, kidney and other organ diseases can also develop which can lead to further problems with needing to consume many different medications and accruing large healthcare costs as well. With a diet change, an increase in physical activity and the right mindset, insulin resistance can be treated and reversed for good.

*As pharmacists, once we start to have conversations with patients about lifestyle modifications, we can change the healthcare system for good.*

References: 

1. Zatterale, F., Longo, M., Naderi, J., Raciti, G. A., Desiderio, A., Miele, C., & Beguinot, F. (2020). Chronic adipose tissue inflammation linking obesity to insulin resistance and type 2 diabetes. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.01607

Semaglutide (Ozempic ®, Wegovy ®) has gained attention recently for not only treating type 2 diabetes, but mainly for its weight loss potential. As a GLP-1 receptor agonist, semaglutide works by regulating appetite and reducing food intake, leading to significant weight loss in clinical trials. This drug has shown promising results in helping individuals with obesity manage their weight and improve their overall health. However, can it possibly be…dangerous? 

What are the side effects of Semaglutide? 

The side effects of semaglutide and other GLP-1 agonists are: 

• Nausea
• Vomiting 
• Diarrhea
• Abdominal pain
• Constipation

The warnings and precautions that associated with semaglutide and other medications in its class are: 

• Risk of thyroid C-cell tumor 
• Pancreatitis 
• Diabetic retinopathy complications
• Acute Kidney Injury

However, one effect that is becoming more noticeable is facial drooping or also called, “Ozempic face”. 

What is “Ozempic face’

“Ozempic face” is caused by the rapid decrease in weight and despite the name, it can occur from any medication in the class of GLP-1 agonists not just from the brand name itself. Because the weight is coming off at a faster than normal pace, patients often get an appearance of a drooling face caused by sagging of the skin. 

How can you treat “Ozempic face”? 

There is no treatment for this condition, however, there are ways to treat or lessen this side effect of the medication class as a whole. 

• Incorporating a healthy diet. Although semaglutide and other medications in this class do have strong gastrointestinal side effects, it is still important to obtain a healthy diet. This may include focusing on whole, nutrient-dense foods such as fruits, vegetables, lean proteins, and healthy fats, while limiting intake of processed and high-sugar foods. This is even more crucial to implement because the portion sizes will be smaller for you since you will probably not want to eat as much due to the loss of appetite effects of the medication. If able to, be sure to work with a healthcare professional or registered dietitian to create a personalized nutrition plan that takes into account individual needs, goals, and medication use.
• Having an end goal weight. Knowing and discussing with your healthcare provider a realistic end weight goal while on these medications will help you to stay motivated and focused on achieving your desired weight loss results. This will also give you a chance to evaluate when you should come off the medication since this type of treatment is not recommended for long-term use for weight loss. 
• Resistance training. This is also a critical component because although cardio is important for weight loss and heart health, resistance training will help to prevent skin sagging by building and maintaining muscle mass, which can help fill out loose skin. Grabbing some dumbbells or resistance bands and trying some muscle building exercises will not only help with skin sagging issues but will also help with fat loss and insulin resistance. However, it is important to note that the exact impact of resistance training on skin sagging may vary depending on individual factors such as age, weight loss history, and genetics.

Obesity is a serious condition that is affecting both children and adults in the United States. Obesity related conditions include heart disease, type 2 diabetes, stroke and certain types of cancers. Although semaglutide and other GLP-1 agonists medications can help treat patients with obesity, it should not be used as the only option or long-term treatment as healthy habits should be implemented as the weight loss occurs. Building healthy habits while on these medications should be top priority in order to establish sustainable results for the future.

Image courtesy of nationalhyperbaric.com

Unfortunately, post-traumatic stress disorder or PTSD is not uncommon for military veterans, especially those who have experienced combat. Undergoing high stressful situations on a consistent basis can severely damage the brain over time leading to both traumatic brain injury (TBI) and PTSD. This leads to depression and a low quality of life especially for those dealing with life after the military. However, an unconventional yet effective way of treating PTSD seems to be emerging more into the light of the medical world. 

What is PTSD? 

Post-traumatic stress disorder (PTSD) is characterized by intrusive thoughts, nightmares, flashbacks of traumatic events, avoidance of trauma reminders, sleep disturbances and persisting dysregulation of stress responses. According to the U.S Department of Veteran Affairs, at least 7 out of 100 veterans (7%) will experience PTSD. This is serious because most of the veterans that are suffering from PTSD have either attempted or have successfully committed suicide. Currently the only way to treat PTSD include trauma focused psychotherapy and medications. 

What is hyperbaric oxygen therapy? 

Hyperbaric oxygen therapy (HBOT) involves inhaling 100% pure oxygen in a pressurized environment which enhances the amount of oxygen dissolved in the tissues. This combination of hyperoxia and hyperbaric pressure leads to substantial improvement in tissue oxygenation while also targeting various oxygen and pressure-sensitive genes which results in both anti-apoptotic (cell death) and anti-inflammatory effects. This consequently improves mitochondria metabolism and ultimately cell function. 

Image courtesy of royalihc.com

How does HBOT help to treat PTSD?

Simply put, the increased oxygen of HBOT on the brain: 

• Heals damaged brain tissues
• Improves blood flow
• Reduces inflammation
• Promotes growth of new tissue and blood vessels

Image courtesy of pharmacistconsult.com

HBOT has been studied numerous times in patients post-stroke and those who have suffered traumatic brain injury (TBI) which is often combined with PTSD symptoms. However, there are currently no studies with just PTSD diagnosis alone. 

Although HBOT seems as though it may be a new, ground-breaking experimental treatment, it has actually been around for almost a century and pre-dates World War II, as it is used for other conditions as well. The U.S Department of Veterans Affairs have approved and will pay for HBOT treatment for those who suffer from TBI and PTSD who have failed or seen little benefit from traditional treatment methods. 

If you or someone you know is suffering from PTSD, talk to your provider today to discuss options on treatment. Traditional methods of psychotherapy and medications might work for some, but HBOT may be able to provide the most significant benefits with little to no side effects. Here is a resource for those veterans currently suffering from PTSD and TBI that are interested in HBOT. 

On behalf of Pharmacist Consult, we just want to say thank you to those who have served or currently serve in the military and also to those who work beside them as either civilians or contractors. We appreciate everything you all have done and continue to do for the country! 

Reference: 

Brittany Handschiegl, PharmD, MBA

Contributing Writer

Brittany has vast pharmacy experience in the community and corporate settings. Brittany’s primary pharmacy-related interests are chronic condition management, patient accessibility and MTM. In her free time, Brittany enjoys spending time with family, traveling to new locations and trying new recipes. Brittany is a proud graduate of the Doctor of Pharmacy (PharmD) program at Massachusetts College of Pharmacy and Allied Health Sciences in Boston, MA. Brittany is a licensed pharmacist in Massachusetts.

David M. Kaylor, PharmD

Contributing Writer

David M. Kaylor, PharmD (he/him/his) has pharmacy practice experience primarily in the inpatient (hospital) setting. David’s primary interests are related to infectious diseases, anticoagulation, and heart failure. Currently, David is a PGY1 pharmacy resident at UofL Health – UofL Hospital in Louisville, KY. In his free time, David enjoys playing guitar, watching documentaries, and rooting for the Indianapolis Colts and Indiana Pacers. David is a proud graduate of the Doctor of Pharmacy (PharmD) program at Butler University in Indianapolis, IN. David is a licensed pharmacist in Kentucky, USA.

Rebecca Lamore, PharmD

Contributing Writer

Rebecca Lamore, PharmD (she/her/hers) currently practices pharmacy in the outpatient specialty setting. Her passion areas include HIV/hepatitis C and advocating for underserved patient populations. Outside of pharmacy, she enjoys touring new ice cream parlors with her husband but can also be found on long bike rides along the Connecticut shoreline. She is a graduate of the Doctor of Pharmacy program at Butler University in Indianapolis where she also received a bachelor’s degree in Spanish. She is a licensed pharmacist in Connecticut and Indiana.

Cody Morcom, PharmD

Contributing Writer

Cody Morcom, PharmD (he/him/his) has pharmacy practice experience in the areas of community and federal pharmacy. His primary pharmacy-related interests are related to medical misinformation, quackery, vaccines, and leadership. In his free time, Cody enjoys backpacking, traveling, and reading everything he can possibly find. Cody is a proud graduate of the Doctor of Pharmacy (PharmD) program at the Wilkes University Nesbitt School of Pharmacy in Wilkes-Barre, PA. Cody is a licensed pharmacist in Pennsylvania, USA.

Joshua Murdock, PharmD

Founder, Former Head Writer

Joshua Murdock, PharmD (he/him/his) has pharmacy practice experience in the community and corporate settings, the outpatient clinic setting, and in the patient care research setting. Joshua’s primary pharmacy-related interests are related to oncology, specialty pharmacy, and community pharmacy. In his free time, Joshua enjoys travelling, frequenting the gym, playing soccer, and exploring fun new weekend destinations. Joshua is a proud graduate of the Doctor of Pharmacy (PharmD) program at the Butler University College of Pharmacy and Health Sciences in Indianapolis, IN. Joshua is a licensed pharmacist in both Rhode Island, USA and Colorado, USA. Ha

Daniel J. Peterson, PharmD, MBA, MSHI

Contributing Writer

Daniel J. Peterson, PharmD, MBA, MSHI has extensive pharmacy practice experience in the inpatient, health-systems, informatics, management, and leadership settings. His interests include leadership development, pharmacy administration, health informatics, optimized clinical practice, inter- and intra-professional collaboration, medication safety, pharmacy technician advocacy, community activism, educational access and opportunities for all, and financial management, among others. Living a life grounded in Christ is important to him. Hobbies include tennis, cycling, running, hiking, reading, and writing. Daniel is a proud graduate of the University of Iowa Hospitals and Clinics’ PGY1/PGY2/MS Health-System Pharmacy Administration residency program and obtained his Master of Science in Health Informatics (MSHI) from the Graduate College at the University of Iowa in Iowa City, IA. He is also a proud graduate of Butler University’s Doctor of Pharmacy (PharmD) program from the College of Pharmacy and Health Sciences and also obtained his Master of Busines Administration (MBA) from Butler University’s Lacy School of Business in Indianapolis, IN. He is a licensed pharmacist in Indiana, USA and Iowa, USA

Celeste Small, PharmD

Head Writer

Celeste Small, PharmD (she/her/hers) currently practices pharmacy the Patrick Space Force Base in Cocoa Beach, FL. Her interests are medical writing and chronic conditions such as diabetes, heart disease, geriatrics, nutrition, and non-sterile compounding. She also has a unique experience in being able to measure and order certain medical supplies such as compression stockings for patients with vein issues. She is a freelance medical writer on the side and has written content for blogs, presentations, and for educational material. In her free time, she enjoys travelling, going to theme parks, listening to music and enjoying the Florida sun. Celeste is a proud graduate of the University of South Florida in Tampa, FL where she obtained both her Bachelor’s of Science and Doctorate of Pharmacy. Celeste is licensed pharmacist in Florida.

Mandeep Sohal, PharmD

Contributing Writer

Mandeep Sohal, PharmD (he/him/his) is a residency trained pharmacist that has completed the PGY-1 Specialty Innovation Managed Care Residency with CVS Health/CVS Specialty based out of Lincoln, Rhode Island, and he is currently licensed in California, Massachusetts, and Rhode Island. Presently, he is a Clinical Operations Advisor serving the Aetna Medicaid line of business with CVS Caremark. During his time on the Specialty Innovation team, he supported digital clinical programs, including an oncology pilot and a specialty product launch. He presented the findings of the pilot at the American Society of Clinical Oncology (ASCO) annual meeting and presented an analysis of CVS Specialty digital clinical programs at the Academy of Managed Care Pharmacy (AMCP) annual meeting. Prior to this, he graduated from USC School of Pharmacy in Los Angeles, CA in 2019. Mandeep Sohal’s primary pharmacy-related interests are related to specialty pharmacy, formulary management, utilization management, and digital clinical programs. In his spare time, he enjoys boxing, weight-lifting, and investing.

Laura Sosinski, PharmD, MBA

Contributing Writer

Laura Sosinski, PharmD, MBA (she/her/hers) is a graduate of Butler University in Indianapolis, IN where she received her Doctor of Pharmacy and Masters in Business Administration. Laura is a licensed pharmacist in Illinois and Indiana. While in school, Laura worked in community pharmacy for 5 years. Currently she is completing her Post-Graduate Year 1 training at NorthShore University HealthSystem in the Chicagoland area. Her pharmacy related interests include: Medication Safety, Oncology, Transitions of Care, and Advocacy. In her free time, Laura enjoys kick boxing and trying new recipes! Her passions include supporting local businesses and speaking up for those who don’t have a voice.

Brian Wenger, PharmD

Contributing Writer

Brian Wenger, PharmD (he/him/his) has pharmacy practice experience primarily in the inpatient setting, but also ambulatory care and community pharmacy settings. Brian’s career-related interests include primary care & chronic disease state management, academia, and public health/equity in healthcare. In his free time, Brian enjoys traveling, listening to new music, and watching the Chicago Bulls. Brian is a proud graduate of the Doctor of Pharmacy (PharmD) program at Butler University in Indianapolis, IN. Brian is a licensed pharmacist in the state of Indiana.

Kennedy Valinevicius, PharmD, RPh

Contributor Writer

M. Kennedy Valinevicius has vast pharmacy practice experience in the community based and large-network inpatient facilities that include alcohol/addiction specialized practices. Her primary pharmacy-related interests are related to addiction/psychiatric medicine, emergency medicine and process improvement initiatives. In her free time, Kennedy enjoys fitness, being outdoors, and traveling. M. Kennedy Valinevicius is a proud graduate of the Doctor of Pharmacy (PharmD) program at Butler University in Indianapolis, IN. Kennedy is a licensed pharmacist in Indiana and Arizona.

Cameron Miller

Contributor Writer

Cameron Miller is a freelance medical writer specializing in content for B2C medical and pharmaceutical brands. Through his work, he hopes to shed light on otherwise confusing industries so that the consumer can make more informed choices, ultimately helping people take control of their own health.

Image via Ascend Medical

In the United States, 1 in 5 (over 14 million), children and adolescents are affected by obesity. There are various contributing factors to excess weight gain in this patient population including behavior, genetics, certain medications, child care and school environments. Obesity related problems that can occur in children are high blood pressure, high cholesterol, type 2 diabetes and breathing problems such as asthma and sleep apnea. If a child experiences obesity while they’re young, most of the time, it will continue into adulthood. 

The days of “watchful waiting” or delaying treatment to see if children and adolescents outgrow obesity are over as excess weight gain continues to increase among this group. The American Academy of Pediatrics (AAP) has recommended that certain drugs can be used for weight loss treatment in children mostly 12 years (some even younger) and up. 

Metformin

Although metformin is used in the treatment of Type 2 diabetes, it has many other indications not approved by the FDA including weight loss. In fact, only a modest reduction in BMI was shown in adults in a 2020 meta-analysis. However, studies with both adolescents and children showed conflicting results in lowering BMI when taking metformin. Metformin works on diabetes by decreasing glucose production in the liver which reduces glucose levels in the blood and also increases insulin sensitivity in the cells. The adverse effects of this medication include nausea, bloating, flatulence and diarrhea which can be immensely uncomfortable especially for young children. 

Orlistat (Alli ®, Xenical ®) 

Orlistat works by blocking fat absorption in the intestine by inhibiting an enzyme called lipase. Currently it is approved for children 12 years of age and older. Although studies have shown it worked well in lowering BMI in adolescents, the adverse effects of this medication has caused this medication to be unfavorable in the pediatric population. The side effects include steatorrhea, fecal urgency and flatulence.  

Image via Wall Street Journal

Glucagon-like peptide-1 receptor agonists (GLP-1 agonist) 

GLP-1 agonist was originally approved for the treatment of Type 2 diabetes. Liraglutide (Victoza ®), dulaglutide (Trulicity ®), exenatide (Bydureon ®) and semaglutide (Wegovy ®) are a part of this class of medications and mainly work by slowing gastric emptying thus causing a decrease in hunger. Because of appetite reducing effects, these medications have recently gained immense popularity in people without diabetes who are overweight or obese or looking to drop extra pounds which has caused them to become short in supply throughout the country. 

Recently, the FDA has approved liraglutide for treatment of obesity in children 12 years or older. Exenatide is currently approved in children ages 10 to 17 with type 2 diabetes. The adverse effects of this class include nausea and vomiting, there is also a risk of medullary thyroid cancer in patients with a family history of this condition. 

Image via STAT

Phentermine 

Phentermine works by inhibiting the reuptake of norepinephrine, serotonin and dopamine thus reduces appetite in patients who are obese. Adverse effects of this medication include elevated blood pressure, dizziness, headache, tremor, dry mouth and stomach ache. Because of these effects, this is a short term option (3 months) for patients adolescents aged 16 years or older. And if after 3 months there is no reduction in weight, another weight loss option should be considered. 

Topiramate 

Topiramate was originally used as an anti-seizure medication and for migraines but also has appetite suppressing effect, especially when combined with phentermine (Qsymia ®). The major adverse effects of topiramate is cognitive slowing which can interfere with school and day to day life activities. It also is associated with birth defects and patient counseling must be completed upon patient starting, especially if they are child-bearing age. 

Lisdexamfetamine (Vyvanse ®) 

Lisdexamfetamine has a similar mechanism to phentermine however is a stimulant used in ADHD for patients aged 6 and older. This medication also has an indication for treatment of binge eating disorder in patients aged 18 and older and can be used off-label for obesity in children. However, there is no data that has reviewed the safety or efficacy for childhood obesity. 

Although medications can help in the treatment of obesity in children, it is important to remember lifestyle modifications should always be in the forefront of therapy. Exercising, eating a healthy diet and avoiding processed foods can have a huge effect in the weight loss of children. Also developing healthy habits while young can allow children to maintain them during adulthood which leads to a long, healthy and successful life.  

Reference: 
1. Sarah E. Hampl, Sandra G. Hassink, Asheley C. Skinner, Sarah C. Armstrong, Sarah E. Barlow, Christopher F. Bolling, Kimberly C. Avila Edwards, Ihuoma Eneli, Robin Hamre, Madeline M. Joseph, Doug Lunsford, Eneida Mendonca, Marc P. Michalsky, Nazrat Mirza, Eduardo R. Ochoa, Mona Sharifi, Amanda E. Staiano, Ashley E. Weedn, Susan K. Flinn, Jeanne Lindros, Kymika Okechukwu; Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics February 2023; 151 (2): e2022060640. 10.1542/peds.2022-060640.