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BOSTON — Doctors continue to prescribe the antidepressant amitriptyline for treatment of diabetic peripheral neuropathy in the elderly despite advisories that discourage its use in this population, according to study findings reported at the annual meeting of the American Pain Society.
“Amitriptyline has been studied for a long time in diabetic neuropathy, so we were not surprised it's used,” said lead author Ariel Berger, MPH, of Policy Analysis Inc., Brookline, Mass., in an interview. “What was surprising to us was that nearly half of patients had evidence of potentially inappropriate prescribing. [Physicians] had red alerts, prior to beginning therapy, but they prescribed them anyway.”
Mr. Berger and his associates at Pfizer Inc. and Oregon Health and Science University, Portland, identified all patients in a large health-claims database who were diagnosed with diabetic peripheral neuropathy, were aged 65 years or older, and had received a prescription for a tricyclic antidepressant (TCA).
The researchers documented which specific TCAs the patients received, their average daily dose, and the number of medication refills. Finally, they documented specific contraindications, warnings, and precautions listed on the TCA package inserts and compared these with the patients' medical records.
A total of 296 elderly patients received a prescription for a TCA. Nearly half (45.3%) had a diagnosis (cardiovascular disease) or concurrent prescription (thyroid medication) listed among the contraindications, warnings, or precautions in TCA product labeling.
Eight out of 10 who received TCAs received amitriptyline, considered by many to pose the most risk for patients over age 65 years.
Guidelines for the treatment of older patients advise physicians that TCAs in general—and amitriptyline in particular—are potentially dangerous in the elderly. In 1999, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) recommended the use of nortriptyline in its place.
The package insert for amitriptyline advises doctors to carefully monitor patients with cardiovascular disorders and notes that the medication can cause cardiac arrhythmias, sinus tachycardia, myocardial infarction, and stroke, as well as both elevated and depressed blood sugar levels.
Pfizer, the study sponsor, has received FDA approval to market the anticonvulsant pregabalin for treatment of diabetic peripheral neuropathy.
BOSTON — Doctors continue to prescribe the antidepressant amitriptyline for treatment of diabetic peripheral neuropathy in the elderly despite advisories that discourage its use in this population, according to study findings reported at the annual meeting of the American Pain Society.
“Amitriptyline has been studied for a long time in diabetic neuropathy, so we were not surprised it's used,” said lead author Ariel Berger, MPH, of Policy Analysis Inc., Brookline, Mass., in an interview. “What was surprising to us was that nearly half of patients had evidence of potentially inappropriate prescribing. [Physicians] had red alerts, prior to beginning therapy, but they prescribed them anyway.”
Mr. Berger and his associates at Pfizer Inc. and Oregon Health and Science University, Portland, identified all patients in a large health-claims database who were diagnosed with diabetic peripheral neuropathy, were aged 65 years or older, and had received a prescription for a tricyclic antidepressant (TCA).
The researchers documented which specific TCAs the patients received, their average daily dose, and the number of medication refills. Finally, they documented specific contraindications, warnings, and precautions listed on the TCA package inserts and compared these with the patients' medical records.
A total of 296 elderly patients received a prescription for a TCA. Nearly half (45.3%) had a diagnosis (cardiovascular disease) or concurrent prescription (thyroid medication) listed among the contraindications, warnings, or precautions in TCA product labeling.
Eight out of 10 who received TCAs received amitriptyline, considered by many to pose the most risk for patients over age 65 years.
Guidelines for the treatment of older patients advise physicians that TCAs in general—and amitriptyline in particular—are potentially dangerous in the elderly. In 1999, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) recommended the use of nortriptyline in its place.
The package insert for amitriptyline advises doctors to carefully monitor patients with cardiovascular disorders and notes that the medication can cause cardiac arrhythmias, sinus tachycardia, myocardial infarction, and stroke, as well as both elevated and depressed blood sugar levels.
Pfizer, the study sponsor, has received FDA approval to market the anticonvulsant pregabalin for treatment of diabetic peripheral neuropathy.
BOSTON — Doctors continue to prescribe the antidepressant amitriptyline for treatment of diabetic peripheral neuropathy in the elderly despite advisories that discourage its use in this population, according to study findings reported at the annual meeting of the American Pain Society.
“Amitriptyline has been studied for a long time in diabetic neuropathy, so we were not surprised it's used,” said lead author Ariel Berger, MPH, of Policy Analysis Inc., Brookline, Mass., in an interview. “What was surprising to us was that nearly half of patients had evidence of potentially inappropriate prescribing. [Physicians] had red alerts, prior to beginning therapy, but they prescribed them anyway.”
Mr. Berger and his associates at Pfizer Inc. and Oregon Health and Science University, Portland, identified all patients in a large health-claims database who were diagnosed with diabetic peripheral neuropathy, were aged 65 years or older, and had received a prescription for a tricyclic antidepressant (TCA).
The researchers documented which specific TCAs the patients received, their average daily dose, and the number of medication refills. Finally, they documented specific contraindications, warnings, and precautions listed on the TCA package inserts and compared these with the patients' medical records.
A total of 296 elderly patients received a prescription for a TCA. Nearly half (45.3%) had a diagnosis (cardiovascular disease) or concurrent prescription (thyroid medication) listed among the contraindications, warnings, or precautions in TCA product labeling.
Eight out of 10 who received TCAs received amitriptyline, considered by many to pose the most risk for patients over age 65 years.
Guidelines for the treatment of older patients advise physicians that TCAs in general—and amitriptyline in particular—are potentially dangerous in the elderly. In 1999, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) recommended the use of nortriptyline in its place.
The package insert for amitriptyline advises doctors to carefully monitor patients with cardiovascular disorders and notes that the medication can cause cardiac arrhythmias, sinus tachycardia, myocardial infarction, and stroke, as well as both elevated and depressed blood sugar levels.
Pfizer, the study sponsor, has received FDA approval to market the anticonvulsant pregabalin for treatment of diabetic peripheral neuropathy.