Drug information in pregnancy. Attitudes and needs among pregnant women and physicians

Background: Drug use in pregnancy is common and both pregnant women and their physicians are in need of appropriate information for decision-making regarding drug therapy. However, uncertainty about the risks of drug use in pregnancy could result in restrictive attitudes to prescribing medicines and to their use. Purpose: To examine attitudes of and needs for medicines information among pregnant women and physicians. Materials and methods: Four studies based on three different methods were included; I: a descriptive study comparing drug advice regarding pregnancy from two commonly used sources: the Norwegian Drug Information Centres (DICs, named RELIS) and the product monographs in Felleskatalogen (FK), II: a survey among physicians who consulted RELIS for information on patient-specific drug use during pregnancy, III: interviews of pregnant women with epilepsy (WWE) using antiepileptic drugs (AEDs), IV: a survey among women attending ultrasound examination in gestation weeks 17-19 and their respective general practitioners (GPs). Results: Commonly used sources of information differed in advice regarding drug use in pregnancy. RELIS was a valued service among physicians and most advice had a clinical impact on therapeutic decisions. Pregnant WWE were confident in using AEDs through communication with their neurologist, but were concerned about dose adjustments. Pregnant women had higher teratogenic risk perceptions and lower confidence in use of medicines compared to their GPs. Phrasing of information texts may have influenced teratogenic risk perceptions. Conclusions and further implications: Deciding whether or not to prescribe or use medicines in pregnancy may be influenced by teratogenic risk perceptions, phrasing of medicines information, differences in advice between sources of information and availability of patient-specific and producer-independent medicines information. Physicians should aim to tailor the information to the pregnant woman’s risk perception level and desire for information

Quetiapine, Misuse and dependency: A case-series of questions to a Norwegian network of drug information centers

Purpose: The second-generation antipsychotic quetiapine has been associated with misuse and dependency. We aimed to review questions to the Norwegian network of drug information centers concerning this potential drug safety problem. Methods: We conducted a Boolean search in the database of the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS) combining the indexed categories “quetiapine” and “adverse drug reaction” with the text words “misuse” or “dependency”. Question–answer pairs (Q/As) in the full-text, searchable RELIS database were defined as cases. Cases were analyzed for drug safety issues linked to use of quetiapine, including off-label use, polypharmacy and other patient risk factors. Results: The search resulted in 54 cases. Forty-six cases (85%) were patient-related, and a majority came from physicians working in hospitals. Twenty-nine cases (54%) concerned patients with a history of addiction, 14 cases (26%) had polypharmacy, and off-label use of quetiapine for insomnia was identified in 14 of the cases (26%). Only three of the cases included a specific question about patient dependency of quetiapine, and these cases were all associated with insomnia. Conclusion: We conclude that our case series from the Norwegian network of drug information centres reflects that quetiapine frequently involves clinical narratives of a history of addiction, polypharmacy or insomnia (off-label use). However, the case series did not reveal new information about the drug’s addictive potential.publishedVersio

Analysis of questions about use of drugs in breastfeeding to Norwegian drug information centres

Abstract Background Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice. Methods A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with “BREASTFEEDING” in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used. Results In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician. Conclusions This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug

Quetiapine, Misuse and dependency: A case-series of questions to a Norwegian network of drug information centers

Purpose: The second-generation antipsychotic quetiapine has been associated with misuse and dependency. We aimed to review questions to the Norwegian network of drug information centers concerning this potential drug safety problem. Methods: We conducted a Boolean search in the database of the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS) combining the indexed categories “quetiapine” and “adverse drug reaction” with the text words “misuse” or “dependency”. Question–answer pairs (Q/As) in the full-text, searchable RELIS database were defined as cases. Cases were analyzed for drug safety issues linked to use of quetiapine, including off-label use, polypharmacy and other patient risk factors. Results: The search resulted in 54 cases. Forty-six cases (85%) were patient-related, and a majority came from physicians working in hospitals. Twenty-nine cases (54%) concerned patients with a history of addiction, 14 cases (26%) had polypharmacy, and off-label use of quetiapine for insomnia was identified in 14 of the cases (26%). Only three of the cases included a specific question about patient dependency of quetiapine, and these cases were all associated with insomnia. Conclusion: We conclude that our case series from the Norwegian network of drug information centres reflects that quetiapine frequently involves clinical narratives of a history of addiction, polypharmacy or insomnia (off-label use). However, the case series did not reveal new information about the drug’s addictive potential