Category Archives: Controversies

Pharmacogenetic testing: be informed or be misled

 

A guideline consists of treatment recommendations intended to represent evidence-based best practices. Guidelines often appear in synchrony with dissemination of new information or emergence of new technology, informing their introduction to practice amid better-established treatments that have proved insufficiently effective or tolerable. In the example of applying genotype-inferred phenotypes intended to minimize adverse effects of slow metabolism and/or drug-drug … Read the rest

Parkinsons disease, extrapyramidal symptoms, and antidepressants: causal relationship or artifact of attribution ?

 

 

Extrapyramidal symptoms occasionally have been reported over the last twenty-five years in association with antidepressant monotherapy, and although the correspondents of that anecdotage have implied a causal association, the latter has not been established, not only because it is the exception (by far) bestriding the rule, but because the foundational indication for which antidepressants were approved is itself … Read the rest

ADHD over the lifecycle (overreached and underwrought)

The most impressive feature of this review of attention deficit/hyperactivity disorder (ADHD) in adults, by a non-commercial consortium of Western European researchers (B. Franke and colleagues, European Neuropsychopharmacology, published on the Web on August 1, 2018) is its 267 references citing foundational content of a construct that seems more crepuscular with increasing documentation. That is because the documentation describes … Read the rest

Cardiovascular adversity during long-term pharmacotherapy of ADHD: rare but serious

Arguably the most serious adverse effects of amphetamine, since its synthesis in Germany in 1935, and the most serious adverse effects of related stimulants, is subsumed under “vascular adverse effects,” a subsumption that heretofore has manifested as catastrophic vascular adverse effects, such as sudden-onset myocardial infarction, cerebrovascular accidents, aneurysms of great vessels and their proximal branches at visceral sites, and … Read the rest

Drug concentration-QTc correlation and pharmacology’s “simple” foundational principle

The principle on which the authors of a recent study (S. Gurkan and colleagues, Clinical Pharmacology and Drug Development, published on the Web, ahead of print, on July 27, 2018) base a novel screening test for propensities of drugs to induce prolongation of QTc is a special case of the foundational principle of pharmacology—that effects of pharmacologically active compounds … Read the rest