FDA Experts Urge Ban on Cold Medicines for Young Children

(HealthDay News) -- U.S. health experts on Friday urged the federal Food and Drug Administration to consider banning the sale of over-the-counter cough and cold medicines for young children.

The recommendation, from FDA safety officials, would apply to decongestant use in children under 2, and antihistamines in those younger than 6, according to agency documents released Friday, the Associated Press reported.

The products include approximately 800 popular medicines that are sold in the United States under names like Toddler's Dimetapp, Triaminic Infant and Little Colds, The New York Times reported.

A group of outside experts advising the FDA will consider the recommendation during a meeting on Oct. 18 and 19, and will then offer an opinion to the full agency.

In the safety review released Friday, the FDA experts recommended that all infant cough and cold products be removed from the market. They also recommended that the sizes of the droppers, cups and syringes packaged with products be standardized to reduce the possibility of confusion and overdose, the Times said.

An FDA review of records filed with the agency between 1969 and September 2006 found 54 reports of deaths in children associated with decongestant medicines made with pseudoephedrine, phenylephrine or ephedrine. It also found 69 reports of deaths associated with antihistamine medicines containing diphenhydramine, brompheniramine or chlorpheniramine, the AP said.

Most of the deaths were children younger than 2.

The Consumer Healthcare Products Association, which represents makers of over-the-counter medicines, backs the recommendation that the cold and cough treatments not be used in children younger than 2. As for antihistamines, the group recommends adding a warning that the drugs not be used to sedate young children, the AP said.

Also Friday, FDA officials announced a crackdown on drug companies that make unapproved prescription drugs containing the narcotic hydrocodone, which is used as a cough suppressant and pain killer.

Hydrocodone is one of the strongest drugs used to treat pain or to suppress cough. It's also widely abused and, if improperly used, can lead to illness and death. Overdoses of hydrocodone can cause breathing problems or cardiac arrest and can impair motor skills and judgment, U.S. Food and Drug Administration officials said.

"The FDA is announcing an action to stop the illegal marketing of any unapproved drug product containing hydrocodone," Deborah M. Autor, director of the agency's Office of Compliance, Center for Drug Evaluation and Research, said during a Friday teleconference.

Some pain-relief products containing hydrocodone, such as Vicodin, are FDA-approved. But most of the drugs with hydrocodone now marketed to suppress coughs have not been approved, officials said.

Autor said the unapproved products are made by some 100 manufacturers.

The FDA said it was particularly concerned about improper pediatric labeling of unapproved hydrocodone cough suppressants -- also known as antitussives. None of the drugs that contain hydrocodone has been approved for children younger than 2 years old.

"There are hydrocodone-containing products on the market that claim they are suitable for children as young as 2," Autor said.

Also, many of the products don't carry the proper warning label and often have similar names to other medications, creating a high risk of medication error, Autor added.

"Product names are so similar that the wrong doses or wrong medication may be dispensed," she said.

Hydrocodone is a narcotic regulated by the U.S. Drug Enforcement Administration, Autor said.

Friday's announcement came one day after President George W. Bush signed a five-year renewal of a law that helps fund the FDA's ability to oversee prescription drug safety.

The new law allows the FDA to collect higher fees from drug and medical device makers, which helps defray the agency's costs of reviewing products submitted for approval. The law also gives the agency more powers to take action when there are problems with drugs already on the market. For example, the FDA can order drug companies to do further studies on the safety of medicine and to put new label warnings on products. The agency now has the authority to fine companies that fail to comply with such orders.

Under the new law, the Food and Drug Administration Amendments Act of 2007, drug and medical device companies must also publicly release results of all clinical trials that show how well approved drugs performed, according to published reports.

But the FDA's ability to oversee clinical trials was called into question Friday with the release of a highly critical report by the inspector general of the U.S. Department of Health and Human Services.

In the report, Daniel R. Levinson said he found that FDA officials didn't know how many clinical trials were being conducted and audited fewer than 1 percent of clinical testing sites. In the few instances where FDA inspectors did check a site, they generally showed up long after the tests had been completed, Levinson noted, the Times reported.

The FDA has 200 inspectors to monitor about 350,000 testing sites. Even when inspectors identified serious problems in human clinical trials, top FDA officials downgraded the inspectors' findings 68 percent of the time, Levinson found. In the rest of the cases, it was rare for the FDA to follow up with inspections to assess whether corrective actions ordered by the agency had been done, the Times reported.

The Levinson report echoes other recent criticisms of the FDA's oversight of imported food, foreign drug manufacturers, animal food and medication safety.

In announcing Friday's decision on hydrocodone, the FDA said it was prompted to take the action because it had received reports of "medication errors associated with unapproved hydrocodone products and reports of confusion over the similarity of the names of unapproved products to approved drug products."

Autor said that about 2 percent of all prescriptions written in the United States are for unapproved drugs. With some 200 unapproved drugs containing hydrocodone on the market, it's highly likely that most of the prescriptions for cough medicines that contain hydrocodone are for unapproved brands, she said.

Currently, she added, the approved cough medications containing hydrocodone are: TussiCaps, Tussionex Pennkinetic, Hydrocodone Compound, Mycodone Homatropine Methylbromide, Hycodan, Tussigon, and Vicodin.

According to the FDA, companies marketing unapproved hydrocodone products that are labeled for use in children younger than 6 years of age must stop manufacturing and distributing the products by Oct. 31.

Companies making other unapproved hydrocodone drug products must stop manufacturing such products on or before Dec. 31, 2007, and must "cease further shipment in interstate commerce on or before March 31, 2008."

The FDA said there are alternatives to unapproved hydrocodone-containing products. These include one of the seven approved cough medicines that contain hydrocodone as well as other cough suppressants that don't use hydrocodone.

More information
For more on drugs containing hydrocodone, visit the U.S. Food and Drug Administration.

Genes Might Predispose Antidepressant Users to Suicidal Thoughts

(HealthDay News) -- Variations in two genes may help spur suicidal thinking in individuals taking a commonly prescribed antidepressant, research suggests.

Although preliminary, the findings could pave the way for genetic testing to determine which patients with depression are likely to have this unusual but dangerous side effect.

"These findings, if replicated, would provide a way to have a genetic test that would tell us who is at a higher risk of developing suicidal ideation when taking antidepressants," said Dr. Gonzalo Laje, lead author of the study and associate clinical investigator at the U.S. National Institute of Mental Health. "Our long-term goal is to make sure that people with depression can take antidepressants, because treating depression is the best way to avoid suicide," he said.

Other experts stressed the need for more studies before getting too excited about the finding.

"The real key is, does it replicate in another data set? . . . [because] replicating results is rare," said Dr. Michael Slifer, assistant professor of medicine at the University of Miami Institute for Human Genomics. "It's a very important topic," said Slifer, who was not involved in the study.

"Nobody has really looked into what might be different about the background of these folks that have such a difficult time in treatment and get suicidal thoughts. This is a first step, but it's only a first step."

There is some evidence that people starting antidepressant medication can develop suicidal ideation, or suicidal thoughts and ideas, although this notion remains controversial.

In 2004, the U.S. Food and Drug Administration (FDA) recommended that the class of drugs known as selective serotonin reuptake inhibitors (SSRIs) carry a strong "black box" warning on the label outlining the possibility of an increase in suicidal ideation. SSRIs include widely used drugs such as Celexa, Paxil, Prozac and Zoloft.

The black box warning was based on studies that found that 4 percent of the group taking SSRIs had suicidal ideation, compared with 2 percent of the group taking a placebo.

"It is a severe side effect, but it is unusual," Laje stated. "Given the warnings by regulatory agencies, we thought this would be a very important side effect to look at."

The current study was part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the largest trial to date to look at depression in real-world settings. Participants in STAR*D were treated with the SSRI citalopram (Celexa) for up to 14 weeks.

For this study, Laje and colleagues analyzed DNA samples from 1,915 participants, looking for associations between reports of suicidal ideation at 768 sites in 68 genes.

Versions of two genes involved with cellular glutamate receptors, which have been implicated in depression, were more prevalent in participants reporting suicidal thinking.

While overall about 6 percent of the patients reported suicidal thoughts when taking Celexa, 36 percent of patients who carried both of the gene variations reported suicidation. Overall, 59 percent of those who reported suicidal ideation had at least one of the suspect gene types.

One percent of the participants had a version of the kainate receptor gene (GRIK2) that increased the risk of suicidal thinking more than eightfold.

Forty-one percent had a version of the AMPA receptor gene (GRIA3) that almost doubled the odds.

Eleven participants, or one-half of one percent, had both versions which resulted in a 15-fold increase in risk.

Since the researchers only looked at Celexa, it's unknown if the findings extend to other antidepressants, even those in the same class of SSRIs.

This study, which is published in the October issue of the American Journal of Psychiatry, is the first to find a significant association between a genetic marker and suicidal ideation.

Researchers elsewhere are working to further clarify the links, if any, between antidepressant use and suicide ideation.

On Thursday, scientists led by Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center, announced the launch of a large-scale safety registry tracking antidepressant use by children and youth.

In its first study, the Child and Adolescent Psychiatry Trials Network (CAPTN) hopes to follow the outcomes of 2,420 children and adolescents prescribed either an SSRI or another type of drug, a serontonin-norepinephrine reuptake inhibitor (SNRI) to help treat depression, anxiety disorders, and other psychiatric woes. A subset study will examine gene variants associated with an increase in either the benefits or side effects of psychiatric medicines in young users.

The CAPTN effort is funded by the U.S. National Institute of Mental Health.

More information
There is more on suicide prevention at the U.S. National Institute of Mental Health.

Doctors' Office Outreach Boosts Colon Cancer Screening

(HealthDay News) -- Simple, personalized outreach in doctors' offices can improve colorectal cancer screening rates, a new study finds.

Colorectal cancer is the third most common kind of cancer and the third leading cause of cancer death in the United States. Most patients don't experience any symptoms until the disease is in an advanced stage, which means that early screening is critical to saving lives.

However, studies show that only 42 percent of Americans have received fecal testing for blood or endoscopy screening for colorectal cancer in the previous five years.

In this study of 1,546 people at risk for colorectal cancer, researchers from Thomas Jefferson University in Philadelphia examined the effectiveness of standard and tailored educational interventions in primary practice settings.

The participants were randomly assigned to: no intervention/control; standard intervention (SI) with mailing of education and screening supplies; tailored intervention (TI) with mailing of education and screening supplies; or tailored intervention plus one-year phone follow-up (TIP).

Two years later, colorectal cancer screening rates were 48 percent in the TIP group, 46 percent in the SI group, 44 percent in the TI group, and 33 percent in the SI group.

"These findings provide support for the use of simple, personalized interventions in primary care practice settings to increase CRC screening use among adult patients who are not up to date with CRC screening guidelines," the study authors concluded.

The study was expected to be published in the Nov. 1 issue of the journal Cancer.

More information
The U.S. National Cancer Institute has more about colorectal cancer screening.


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