Women and Medications - Women's Health Highlights: Recent Findings (continued)

Women's Health Highlights: Recent Findings
Women and Medications
AHRQ has a growing research program focused on medication use by women, including the use of antibiotics, contraceptives, drugs to prevent or treat osteoporosis, and hormone replacement therapy to ease the symptoms of menopause. AHRQ also supports studies focused on medication safety, the cost of medications, and other related topics. Examples of recent findings from these studies include the following.

•Drug treatment for overactive bladder symptoms produces modest results.
About 11 million U.S. women have overactive bladder syndrome and have symptoms such as strong urges to urinate, difficulty waiting to go, and involuntary loss of urine when they have an urge to urinate. A review of available evidence found that drug therapy and behavioral interventions produce modest results in reducing overactive bladder symptoms in women, while complementary and alternative therapies appeared to be ineffective. Surgical and procedural interventions were effective in some women, but more information is needed on their safety and effectiveness. Treatment of Overactive Bladder in Women, Evidence Report/Technology Assessment No. 187 (AHRQ Publication No. 09-E017)* (AHRQ contract 290-2007-10065-I).

•Women are prescribed more drugs than men during their reproductive years.
According to this study, women in their reproductive years received more prescriptions than men in 48 of 53 drug classes. These included drugs commonly used to treat urinary tract and vaginal infections, migraine headaches, mental health conditions, pain, and gastrointestinal ailments. As they aged, the prescribing patterns changed; men received more drugs than women for angina, heart failure, high blood pressure, elevated cholesterol, and risk of blood clots, even though older women suffer from these conditions at the same rate as men. Anthony, Lee, Bertram, et al., J Women's Health 17(5):735-743, 2008 (AHRQ grant HS17001).

•Pregnant women continue to receive a class of high blood pressure medications dangerous to the fetus.
Use of antihypertensive angiotensin-converting enzyme (ACE) inhibitors is contraindicated during the second and third trimesters of pregnancy because they are dangerous to the fetus, yet the number of pregnant women prescribed these medications increased steadily between 1986 and 2003, according to this study. This increase was despite an FDA black box warning against such use issued in 1992. The researchers examined data on 262,179 Medicaid-enrolled pregnant women and found that the use of ACE inhibitors increased 4.5-fold (from 11.2 to 58.9 per 10,000 pregnancies) during the study period. Bowen, Ray, Arbogast, et al., Am J Obstet Gynecol 198:291,e1-291,e5, 2008 (AHRQ grant HS10384).

•Use of oral diabetes agents or insulin to treat gestational diabetes appears beneficial, and the likelihood of harm is low.
This review of the evidence focused on the risks and benefits associated with use of an oral diabetes agent compared with all types of insulin for gestational diabetes. Other areas reviewed include any risk factors that might be associated with the development of type 2 diabetes after gestational diabetes; the reliability of diagnostic tests for type 2 diabetes in women with gestational diabetes; and whethet there is evidence that elective labor induction, cesarean delivery, or timing of induction is associated with risks and benefits for mother and neonate. Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes, Evidence Report/Technology Assessment No. 162 (AHRQ Publication No. 08-E004)* (AHRQ contract 290-02-0018).

•Use of antidepressants during pregnancy carries risks for preterm birth and other problems.
Researchers identified 2,201 women who were prescribed an antidepressant during pregnancy and subsequently delivered an infant within one of five large managed care organizations. They found that full-term infants exposed to selective serotonin reuptake inhibitors (SSRIs) during the third trimester had a higher risk of respiratory distress syndrome, endocrine and metabolic disturbances, low blood sugar levels, temperature regulation disorders, and convulsions. Infants exposed to tricyclic antidepressants (TCAs) during the third trimester had the same elevated risks, except for low blood sugar and convulsions. Neither drug was associated with an increased risk for congenital anomalies. Davis, Rubanowice, McPhillips, et al., Pharmacoepidemiol Drug Saf 16:1086-1094, 2007 (AHRQ grant HS10391). See also Cooper, Willy, Pont, and Ray, Am J Obstet Gynecol 196(6):544e1-544e5, 2007 (AHRQ grant HS10384).

•FDA Class D and X medications are given to a small percentage of pregnant women.
Class D and X medications should not be given to pregnant women because they can harm the fetus. Category D drugs include progesterone, tetracycyline, aspirin, cortisone, Retin-A, and lithium; category X drugs include oral contraceptives and estrogen, medroxyprogesterone, simvastatin, trazolam, and warfarin. This survey found that prescriptions for D and X drugs accounted for 6.4 percent of private physician visits and 2.9 percent of visits to hospital clinics by pregnant women in 1999 and 2000; in 1 of every 10 private physician visits, a pregnant women received a drug with an unknown pregnancy risk. Lee, Maneno, Smith, et al., Pharmacoepidemiol Drug Saf 15:537-545, 2006 (AHRQ grant HS11673).

•Many osteoporosis medications prevent fractures, but none has been shown to be best.
According to this report, not enough scientific evidence exists to establish whether bisphosphonates (the most commonly used osteoporosis drugs) are better at preventing fractures than estrogen, calcitonin, or raloxifene. The report also indicates that many osteoporosis patients stop taking their medications as prescribed. Some stop because they do not have osteoporosis symptoms; others stop because of medication side effects or because dosing is too frequent. Not taking medications as prescribed increases the risk of bone fractures. Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis, Comparative Effectiveness Review No. 12, 2007; online at http://www.effectivehealthcare.ahrq.gov (AHRQ contract 290-02-0003).

•Card offers tips to help women use medicines safely.
This two-sided card explains how medicines may work differently in women and men and what women can do to help make sure their medicines work for them. Tips are provided for creating a medication list, talking with pharmacists and other health care providers about medications, and finding out more information on safe medication use. Your Medicine: Play It Safe (AHRQ Publication No. 03(05)-0019-A)* (Intramural).

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Women's Health Highlights: Recent Findings (continued)