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Drug Withdrawal

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1. Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia. (PubMed)

Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia. Antipsychotic agents are often used to treat neuropsychiatric symptoms (NPS) in people with dementia although there is uncertainty about the effectiveness of their long-term use for this indication and concern that they may cause harm, including higher mortality. When behavioural strategies have failed and treatment with antipsychotic drugs is instituted (...) with psychosis, aggression or agitation who responded well to long-term antipsychotic drug use, or those with more severe NPS at baseline, may benefit behaviourally from continuation of antipsychotics. Discontinuation may reduce agitation for people with mild NPS at baseline. However, these conclusions are based on few studies or small subgroups and further evidence of benefits and harms associated with withdrawal of antipsychotic is required in people with dementia and mild and severe NPS.The overall

2018 Cochrane

2. Benzodiazepine and z-drug withdrawal

Benzodiazepine and z-drug withdrawal Benzodiazepine and z-drug withdrawal - NICE CKS Share Benzodiazepine and z-drug withdrawal: Summary Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which have hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. Benzodiazepines can be grouped into hypnotics and anxiolytics: Hypnotics are used for short term treatment of insomnia and include nitrazepam, loprazolam, lormetazolam, and temazepam. Anxiolytics are effective (...) in alleviating anxiety states and include diazepam, oxazepam, lorazepam, alprazolam, and chlordiazepoxide. Z-drugs are non-benzodiazepine hypnotics, developed to overcome some of the adverse effects of benzodiazepines (such as next-day sedation, dependence, and withdrawal). Like benzodiazepines, they are also GABA receptor agonists. The two z-drugs available in the UK are zolpidem, and zopiclone. Despite warnings regarding the long-term use of benzodiazepines and z-drugs, millions of prescriptions are still

2019 NICE Clinical Knowledge Summaries

3. Ivabradine: European authorities have instituted precautionary measures, but stopped short of withdrawing this drug

Ivabradine: European authorities have instituted precautionary measures, but stopped short of withdrawing this drug Prescrire IN ENGLISH - Spotlight ''In the November issue of Prescrire International - Ivabradine: European authorities have instituted precautionary measures, but stopped short of withdrawing this drug'', 1 November 2015 {1} {1} {1} | | > > > In the November issue of Prescrire International - Ivabradine: European authorities have instituted precautionary measures, but stopped (...) short of withdrawing this drug Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight In the November issue of Prescrire International - Ivabradine: European authorities have instituted precautionary measures, but stopped short of withdrawing this drug FREE DOWNLOAD Ivabradine offers no advantages over other options and is known to have sometimes fatal

2015 Prescrire

4. Postoperative seizure outcome and timing interval to start antiepileptic drug withdrawal: A retrospective observational study of non-neoplastic drug resistant epilepsy (PubMed)

Postoperative seizure outcome and timing interval to start antiepileptic drug withdrawal: A retrospective observational study of non-neoplastic drug resistant epilepsy This study aimed to investigate the impact of timing interval to start AED withdraw (TIW) after surgery on the seizure outcome in non-neoplastic drug resistant epilepsy (DRE). TIW were divided into three groups (respectively,<1 year, 1-<2 years, and ≥2 years). The seizure outcome at the different time points after starting AED (...) withdrawal were compared among three groups. Other factors that related to seizure recurrence and TIW were included into the multiple analysis to investigate the predictors of seizure-free. Altogether, 205 patients were involved in the study. 102 individuals (50%) had seizure recurrence and 127 (62%) had seizure-free at the final follow up. 115 of them have attempted AED reduction and had not seizure recurrence before AED reduction. The rate of seizure-free had no significant difference among people

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2018 Scientific reports

5. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. (PubMed)

Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. Objectives To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.Design Observational cohort study.Setting Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).Participants 201 275 pregnant women with public insurance who (...) were exposed to opioids around the time of delivery and their liveborn infants.Interventions In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids.Main outcome measure Diagnosis of neonatal drug withdrawal in infants exposed in utero to opioids and psychotropic medications compared with opioids

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2017 BMJ

6. Resolution of acenocoumarol-associated calciphylaxis with drug withdrawal. (PubMed)

Resolution of acenocoumarol-associated calciphylaxis with drug withdrawal. Calciphylaxis is a syndrome of cutaneous ischaemic necrosis and ulceration due to arteriolar calcification with subsequent thrombosis, which rarely presents in patients without terminal kidney disease. Recently, several reports of coumarins-associated calciphylaxis have stressed the relevance of anticoagulant therapy as an important risk factor for the development of this condition. We report five cases of acenocoumarol (...) -associated, biopsy-proven calciphylaxis in women aged between 64 and 92 years. The drug had been prescribed for atrial fibrillation and was taken without interruption from 14 to 224 months. Lesions were present for months in all cases and were resistant to multiple therapeutic options, but they resolved only with simple wound care measures 6-14 months after changing the anticoagulant therapy.© 2019 The Australasian College of Dermatologists.

2019 Australasian Journal of Dermatology

7. Correction to: Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature. (PubMed)

Correction to: Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature. The original article [1] contains a minor error whereby the dates for year of first launch and year of first report of adverse reaction for iophendylate in e-Appendix Table 1 are mistakenly presented as 1946 and 1975 respectively.

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2019 BMC Medicine

8. Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis. (PubMed)

Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis. From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision.Costing study and longitudinal cohort study.Tijuana (...) , Mexico.Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study.Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal.During the GF period, the needle and syringe

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2019 BMJ open

9. Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation. Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome. (PubMed)

Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation. Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome. The first aim of this study was to assess the implementation of a sedative and analgesic drug rotation protocol in a PICU. The second aim was to analyze the incidence of withdrawal syndrome, drug doses, and time of sedative or analgesic drug infusion in children after the implementation of the new protocol.Prospective (...) observational study.PICU of a tertiary care hospital between June 2012 and June 2016.All patients between 1 month and 16 years old admitted to the PICU who received continuous IV infusion of sedative or analgesic drugs for more than 4 days were included in the study.A sedative and analgesic drug rotation protocol was designed. The level of sedation, analgesia, and withdrawal syndrome were monitored with validated scales. The relationship between compliance with the protocol and the incidence of withdrawal

2019 Pediatric Critical Care Medicine

10. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. (PubMed)

Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Antipsychotic agents are often used to treat neuropsychiatric symptoms (NPS) in dementia, although the literature is sceptical about their long-term use for this indication. Their effectiveness is limited and there is concern about adverse effects, including higher mortality with long-term use. When behavioural strategies have failed and drug therapy (...) is instituted, regular attempts to withdraw these drugs are recommended. Physicians, nurses and families of older people with dementia are often reluctant to try to stop antipsychotics, fearing deterioration of NPS. Strategies to reduce antipsychotic use have been proposed, but a systematic review of interventions aimed at withdrawal of antipsychotic agents in older people with dementia has not yet been performed.To evaluate whether withdrawal of antipsychotic agents is successful in older people

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2013 Cochrane

11. Withdrawal Management and Treatment of Crystal Methamphetamine Addiction in Pregnancy: A Review of Clinical Effectiveness and Guidelines

withdrawal management or long term treatment for persons who are pregnant and addicted to crystal methamphetamine. Files Rapid Response Summary with Critical Appraisal Published : June 17, 2019 Related Content Follow us: © 2019 Canadian Agency for Drugs and Technologies in Health Get our newsletter: (...) Withdrawal Management and Treatment of Crystal Methamphetamine Addiction in Pregnancy: A Review of Clinical Effectiveness and Guidelines Withdrawal Management and Treatment of Crystal Methamphetamine Addiction in Pregnancy: A Review of Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Withdrawal Management and Treatment of Crystal Methamphetamine Addiction in Pregnancy: A Review of Clinical Effectiveness and Guidelines Withdrawal Management and Treatment of Crystal

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

12. Unfiltered Needles for Withdrawing Medication from Glass Ampoules for Intramuscular Injections: Safety and Guidelines

and Guidelines Last updated: May 23, 2019 Project Number: RA1033-000 Product Line: Research Type: Drug Report Type: Reference List Result type: Report Question What is the safety/harm of using non-filtered needles when withdrawing medication from glass ampules versus vials for intramuscular injections? What are the guidelines regarding the use of unfiltered needles intended for intramuscular administration? Key Message No relevant literature was identified regarding the safety of using unfiltered needles (...) when withdrawing medication from glass ampules versus vials for intramuscular injections. Additionally, no evidence-based guidelines were identified pertaining to the use of unfiltered needles for intramuscular injections. Files Rapid Response Reference List Published : May 23, 2019 Follow us: © 2019 Canadian Agency for Drugs and Technologies in Health Get our newsletter:

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

13. Management of Acute Withdrawal and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines

Management of Acute Withdrawal and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines Management of Acute Withdrawal and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines | CADTH.ca Find the information you need Management of Acute Withdrawal and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines Management of Acute Withdrawal (...) and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines Last updated: February 8, 2019 Project Number: RC1067-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical evidence regarding methods to manage acute detoxification or withdrawal for adults who misuse methamphetamine? What are the evidence-based guidelines regarding the management of acute detoxification

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

14. Blunt Needles for Withdrawing from Multi-dose Vials: Safety and Guidelines

Blunt Needles for Withdrawing from Multi-dose Vials: Safety and Guidelines Blunt Needles for Withdrawing from Multi-dose Vials: Safety and Guidelines | CADTH.ca Find the information you need Blunt Needles for Withdrawing from Multi-dose Vials: Safety and Guidelines Blunt Needles for Withdrawing from Multi-dose Vials: Safety and Guidelines Last updated: April 25, 2019 Project Number: RB1332-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report (...) Question What is the clinical evidence regarding the safety of using blunt needles to withdraw medication or vaccines from multi-dose vials or ampules? What are the evidence-based guidelines regarding needles to withdraw medication or vaccines from multi-dose vials or ampules? Key Message No relevant clinical evidence was identified regarding the safety of using blunt needles to withdraw medication or vaccines from multi-dose vials or ampules. In addition, no relevant evidence-based guidelines were

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

15. Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: A drug beginning to find its expanding niche (PubMed)

Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: A drug beginning to find its expanding niche 28979507 2018 11 13 1751-1437 17 3 2016 Aug Journal of the Intensive Care Society J Intensive Care Soc Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: A drug beginning to find its expanding niche. 271-272 10.1177/1751143716638374 Bowcock Emma E Nepean Hospital, Kingswood, NSW, Australia. Morris Idunn I Nepean Hospital, Kingswood, NSW

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2016 Journal of the Intensive Care Society

16. Pharmacological therapies for management of opium withdrawal. (PubMed)

treatments, different doses of the same drug, and psychosocial intervention, to manage acute withdrawal from opium in a maximum duration of 30 days.We used the standard methodological procedures expected by Cochrane.We included 13 trials involving 1096 participants. No pooled analysis was possible. Studies were carried out in three countries, Iran, India, and Thailand, in outpatient and inpatient settings. The quality of the evidence was generally very low.When the mean of withdrawal symptoms (...) was provided for several days, we mainly focused on day 3. The reason for this was that the highest severity of opium withdrawal is in the second to fourth day.Comparing different pharmacological treatments with each other, clonidine was twice as good as methadone for completion of treatment (risk ratio (RR) 2.01, 95% confidence interval (CI) 1.69 to 2.38; 361 participants, 1 study, low-quality evidence). All the other results showed no differences between the considered drugs: baclofen versus clonidine

2018 Cochrane

17. Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease. (PubMed)

is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations. Withdrawal of immunosuppressant and biologic drugs in patients with quiescent CD may limit adverse events and reduce healthcare costs. Alternatively, stopping these drug therapies may result in negative outcomes such as disease relapse, drug desensitization, bowel damage and need for surgery.To assess the feasibility and safety of discontinuing (...) complications (e.g. fistula, abscesses, strictures) following relapse; the proportion of patients with elevated biomarkers of inflammation (CRP, fecal calprotectin) in those who stop and those who continue therapy; the proportion of patients with anti-drug antibodies and low serum trough drug levels; time to relapse; and the proportion of patients with adverse events, serious adverse events and withdrawal due to adverse events. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence

2018 Cochrane

18. Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. (PubMed)

-CSTD withdrawal (-1.9331 pg/cm², 95% CI -5.1260 to 1.2598; P = 0.20). There is no evidence of difference in the amount of the other drugs between CSTD and control groups in the pharmacy areas or patient-care areas.None of the studies report on atmospheric contamination, blood tests, or other measures of exposure to infusional hazardous drugs such as urine mutagenicity, chromosomal aberrations, sister chromatid exchanges, or micronuclei induction.None of the studies report short-term health benefits (...) Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. Occupational exposure to hazardous drugs can decrease fertility and result in miscarriages, stillbirths, and cancers in healthcare staff. Several recommended practices aim to reduce this exposure, including protective clothing, gloves, and biological safety cabinets ('safe handling'). There is significant uncertainty

2018 Cochrane

19. Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy. (PubMed)

Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy. To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy.We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal (...) MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug.Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2

2018 Neurology

20. Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. (PubMed)

Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. The objective of this study was to create a clinically useful tool for individualized prediction of seizure outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. We used data from the European retrospective TimeToStop study, which included 766 children from 15 centers, to perform a proportional hazard regression analysis. The 2 outcome (...) ) for predicting eventual seizure freedom. An online prediction tool is provided on www.epilepsypredictiontools.info/ttswithdrawal. The presented models can improve counseling of patients and parents regarding postoperative antiepileptic drug policies, by estimating individualized risks of seizure recurrence and eventual outcome.Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

2018 Epilepsia

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