“Pharmacists can use the Medicare.gov Web site to assist Medicare Part D plan enrollees in reducing their out-of-pocket annual expenditures,” concluded Alston and Hanrahan.⁺¹ Six student pharmacists were trained to use the Medicare Plan Finder. Prescription records of 50 patients taking five or more prescription medications were deidentified and reviewed. Nearly all of them (n = 48) would save on their medication expenditures if the recommended program changes were made ($457). Additional savings would have been realized by 54% if generic and therapeutic substitution recommendations were accepted ($1,303). Finally, one-half of the patients would have entered the Medicare coverage gap if they remained on their initial regimen. Afterward, only nine patients would have hit the doughnut hole, and it would have occurred an average of 3 months later (10.6 vs. 7.5 months).

Tisdale et al.⁺² concluded that “sensitivity to drug induced QT interval lengthening is enhanced in patients with systolic HF (heart failure), which may contribute to the increased risk of drug-induced TdP (torsades de pointes).” Six patients with heart failure due to left ventricular dysfunction and nine patients with no known history or current clinical evidence of heart failure were administered 1 mg ibutilide via peripheral in-dwelling catheter. Venous blood samples were collected at multiple times for 48 hours after infusion, and three electroencephalograms were collected at the same time. The average of the QT_F intervals was calculated. Relevant pharmacokinetic and pharmacodynamic parameters were characterized for each sample. No significant differences were found in the maximum QT_F intervals, mean serum concentration, and other pharmacokinetic parameters between the heart failure and control groups. Areas under the effect versus time curves (AUECs_{0–4, 0–8}) were significantly larger and the median EC₅₀ was significantly smaller in the heart failure group.

Implications. Medications other than those used specifically for cardiovascular regulation (e.g., ibutilide) may have an impact on QT interval, including example flouroquinolone antibiotics, tricyclic antidepressants, or certain antipsychotics. The length of the QTc interval has been associated with the risk of sudden death after myocardial infarction, torsades de pointes, and the long QT syndrome. Even at equal concentrations of these medications, individuals with left ventricular dysfunction may be at greater risk of potentially fatal adverse events.

Schumock et al. stated, “Our results … provide preliminary evidence that the association between LTMA (leukotriene receptor–modifying agents) and suicide could be different (i.e., reduced risk) than that which might be anticipated based on previous warnings.”⁺³ Based on case reports, the Food and Drug Administration (FDA) issued a warning about a potential link between LTMAs and suicide beginning in 2008. Annual counts of suicide deaths, prescriptions for LTMAs and antidepressants, and sociodemographic characteristics were obtained for every county in the United States. Counts of LTMA and antidepressant prescriptions dispensed were converted into a rate per 1,000 people. Data were collected for the time period 1999–2006. The annual suicide rate was 11.61 per 100,000 for the entire time period. Adjusting for county-specific demographics and antidepressant use, a negative within-country relationship between suicide and LTMA was obtained for montelukast and no association between suicide and zafirlukast or zileuton.

Implications. The FDA warning was based on case reports, which are potentially biased. This study was an exploratory, ecologic study with study design limitations. However, the results seem to warrant another study that is patient specific.