14 JULY 2023 ausdoc . com . au

Kemal Atlay ADHD pharmacotherapy should be the preferred choice for patients with borderline personality disorder with ADHD symptoms and suicidal behaviour , say Scandinavian doctors who found it was the only treatment to reduce suicide risk .

Their registry-based study showed a 17 % lower risk of suicide attempt or ideation — and half the risk of death by suicide — with use of ADHD drugs compared with non-use .

Conversely , the researchers said benzodiazepines “ should be used with care ” when treating borderline personality disorder ( BPD ) after linking the drug class to a 4.2-fold higher risk of suicide death .

They analysed data from nearly 23,000 Swedes with BPD ( mean age 29 ) to compare the effectiveness of different pharmacotherapies for preventing suicide .

More than 8500 hospitalisations due to a suicide attempt and 316 suicide deaths were recorded during an average of seven years ’ follow-up .

In addition to the main finding , the doctors found that use of antidepressants , antipsychotics and benzodiazepines was associated with a 22-62 % higher risk of suicide attempt or death versus non-use .

“ These findings remained basically the same even when omitting the first 30 or 60 days of each medication exposure period ,” they wrote in JAMA Network Open .

Mood stabilisers had no effect , either positive or negative , the authors added .

They said the reduction in suicide risk with the use of ADHD medications was likely due to overlap in target symptoms — impulsivity and emotion dysregulation — in BPD and ADHD .

“ Meta-analytical evidence indicates that treatment with ADHD medications is associated with decreased impulsivity , which is critical given that impulsivity is one of the strongest predictors of suicidal behaviour in BPD ,” they wrote . JAMA Netw Open 2023 ; 7 Jun .

Ita Buttrose , AC OBE

Before initiating PAXLOVID , patients will need to withhold treatment with any contraindicated medications where it is clinically appropriate to do so , and observe an appropriate washout period . 1

Standard dose of Paxlovid is 300 mg nirmatrelvir and 100 mg ritonavir tablets taken together orally every 12 hours for 5 days . Reduce dose to nirmatrelvir / ritonavir 150 mg / 100 mg every 12 hours for 5 days for patient with moderate renal impairment ( eGFR ≥30 to < 60 mL / min / 1.73m 2 ). 1

PBS information : Authority Required ( STREAMLINED ). Category : GENERAL - General Schedule ( Code GE ). For verified SARS-CoV-2 infection . Treatment must be initiated within 5 days of symptom onset . Refer to PBS Schedule for full authority information .

Reference : 1 . PAXLOVID Approved Product Information .

© 2023 . Pfizer Australia Pty Ltd . Sydney , Australia . All rights reserved . This information is intended only for healthcare professionals . www . pfizer . com . au . Medical Information : 1800 675 229 . www . pfizermedicalinformation . com . au . PFIZ4811 . PP-PAX-AUS-0424 . 02 / 23 .

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Warning : Nirmatrelvir with ritonavir has significant drug-drug interactions . Prescribers and dispensers should carefully review a patient ’ s concomitant medications .

This medicinal product is subject to additional monitoring in Australia . This will allow quick identification of new safety information . Healthcare professionals are asked to report any suspected adverse events at www . tga . gov . au / reporting-problems .

Alternatively , any adverse events which are experienced with PAXLOVID can be reported to Pfizer on 1800 675 229 or by email to AUS . AEReporting @ pfizer . com

Rachel Fieldhouse WOMEN with severe endometriosis are three times more likely to develop gestational diabetes than those with milder forms of the condition , a review shows .

Based on data from 4.6 million women , Italian obstetricians also reported a 23 % higher risk of gestational diabetes ( GDM ) associated with endometriosis compared with controls .

They said endometriosis could be a “ red flag ” for diagnosing GDM and should be included alongside other risk factors routinely assessed during pregnancy .

“ In this sense , the earlier and more specific detection of GDM in women with endometriosis could improve pregnancy management and final maternal – fetal outcomes ,” they wrote in Scientific Reports .

Their analysis of 17 studies included more than 40,000 women with endometriosis . In addition to the main findings , the doctors said the endometriosis – GDM link was unrelated to the method of conception as the risk was not significantly different between those who conceived spontaneously or via assisted reproductive technology ( ART ).

“[ This ] strengthens the idea that endometriosis itself and not [ ART ] treatment determines an increase in GDM risk in women affected by the disease ,” they wrote .

The researchers said systemic inflammation seen in endometriosis could be the trigger given it had also been linked to increased insulin resistance and glucose intolerance .

But they could not exclude the possibility that GDM in this setting could be secondary to sustained inflammation and immune dysregulation and “ therefore would be totally unrelated to the mechanisms underlying the disease aetiology ”. Sci Rep 2023 ; 19 May .