geoffrey modest medical blogs

  A recent systematic review and meta-analysis found that antihistamines provided greater vertigo relief than benzodiazepines (see  vertigo antihistamine better than benzo jamaneurol2022  in  dropbox , or  doi:10.1001/jamaneurol.2022.1858)    Details : -- 17 RCTs were identified with a total of 1586 participants -- diazepam was the major benzodiazepine studied, though lorazepam was used in one study -- antihistamines used included: betahistidine (2 studies), cinnarizine (4 studies), dimenhydrinate (7 studies, this is OTC generic of dramamine), flunarizine (2 studies), meclizine (1 study), and promethazine (2 studies) -- antihistamines were compared with benzodiazepines in 3 studies, with placebo or no treatment in 7 studies, and with other active controls in 6 studies (including methylprednisolone, various repositioning maneuvers, and some others) -- primary outcome: change in 10- or 100-point vertigo or dizziness visual analog scale (VAS) at 2 hours a...

the Alcohol Abuse and Alcoholism (NIAAA) division of NIH just released their analysis of US death certificates, finding almost 1 million people died from alcohol-related causes between 1999-2017, with the number of deaths more than doubling from 1999 to 2017 (see  https://www.nih.gov/news-events/news-releases/alcohol-related-deaths-increasing-united-states  ). For relevant article see  alcohol deaths doubling alc clin exp rsch2019  in dropbox, or  DOI: 10.1111/acer.14239 Details: -- number and rate of alcohol-related deaths by age, sex, race, and ethnicity between 1999 - 2017 for people >16yo from the US National Center for Health Statistics, by death certificates -- deaths were considered to be alcohol-related if alcohol was listed as either an underlying or contributing cause (up to 20 multiple or contributing causes were indicated on the death certificates)     -- acute alcohol-related causes of death included acute behaviora...

The FDA recently published an advisory on the concomitant prescription of benzodiazepines with the opioid addiction medications buprenorphine or methadone, noting that the combination of these opiates with CNS-depressants such as benzos does increase the likelihood of adverse events.   But the potential harm "usually outweighs these risks".    see https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm576755.htm  . They suggest a few things: Recommendations: Providers should: --manage these patients carefully, educating patients about potentially serious risks (including overdose and death), trying to taper the CNS depressants to the lowest level possible, including discontinuation. --verify the diagnosis for the CNS depressants being prescribed --recognize that buprenorphine/methadone, referred to as M AT (medication-assisted opiate treatment) , may continue indefinitely, and should be conti...

​ The BMJ just had an article assessing mortality from benzodiazepines from a large US commercial healthcare database, showing minimal increased mortality risk (see  benzos not increase  mortality BMJ2017  in  dropbox , or doi.org/10.1136/bmj.j2941). Details: -- 1,252,988 randomly selected patients, comparing those initiated on a benzodiazepine during a medical visit within the prior 14 days vs 1,252,988 non-initiators, from 2004-2013 -- all patients were required to fill at least one prescription for any medication both in the 90 days and 91- 180 days before the index date (ie, they were plugged into medical care and filling prescriptions), and high dimensional propensity scoring was done (see below). --  Mean age 46, 85% men, mean Charlson comorbidities score 0.5 (ie, low), 5% smokers, 4% obesity/overweight, 28% hypertension, 1% heart failure, 5% ischemic heart disease, 25% hyperlipide...