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Objectives: To establish the risk of myocardial infarction (MI) in users of hormone replacement therapy (HRT) compared with non-users and to compare the risk between different HRT regimens. Methods: A population-based cohort and case-control study, and a case-control study nested within a cohort of HRT users, using the UK General Practice Research Database. Differences between HRT regimen, mode of administration and duration and recency of use were examined whilst adjusting for confounding. Results: In the cohort and case-control study, 4537 cases of MI were identified in 2.62 million observed women years, cases were age-matched to 27,220 controls. In both studies, current and past HRT use were associated with reduced risk estimates for MI compared with no prior use. MIs were less likely to be fatal amongst women who had used HRT than amongst never users (OR(adj) 0.58; 95% CI 0.45-0.75). No difference in risk was seen between current and past use, oral and transdermal HRT or between different regimens (p>0.44). In the nested study, no difference was found in the association with MI risk between different oestrogen-progestogen combinations or between different combinations and tibolone. Unopposed oestrogen use was not associated with a decrease in risk compared with combined HRT. Conclusions: These results are consistent with previous observational studies in supporting the hypothesis that use of postmenopausal HRT is associated with a decrease in risk of acute myocardial infarction (AMI). Case fatality differed between HRT users and non-users, suggesting a protective effect of HRT. This study does not demonstrate a difference between regimens. [ABSTRACT FROM AUTHOR]

A follow-up study was performed in two ambulatory cohorts aged ⩾65 to investigate whether the prevalence and incidence of anxiolytic/hypnotic benzodiazepine drug prescribing is comparable between users of serotonin reuptake inhibitors (SSRIs) and users of tricyclic antidepressants (TCAs). The prevalence and incidence of benzodiazepines during antidepressant therapy was estimated among users of TCAs and SSRIs. Coprescribing of benzodiazepines occurred in 53% of the TCA users and 57% of the SSRI users (prevalence RR 1.1; CI95 0.9–1.2). The average duration of benzodiazepine drug use was >65 days per 100 days of antidepressant use. During SSRI therapy, significantly more people started benzodiazepine drug therapy than during TCA therapy (incidence rate ratio (RR) 1.7; CI95 1.2–2.4). Analyses repeated 5 years later yielded similar results (overall incidence RRMH 1.6; CI95 1.3–2.0). These data indicate that SSRI use is associated with a significantly higher chance of starting benzodiazepines compared with TCA use. [Copyright &y& Elsevier]

Despite our knowledge regarding the efficacy, tolerability and optimal use of drugs, suboptimal prescribing still occurs. In view of all the factors that influence prescribing, this is not surprising. The focus of drug tolerability has changed from 'choosing the best alternative' when a drug is prescribed, to a balanced decision incorporating various different treatments from separate healthcare providers. This article reviews strategies that may influence prescribing behaviour and discusses practical considerations for achieving optimal prescribing in view of tolerability concerns. The patient has a major influence on prescribing and, with the current diversification of healthcare, the patient now controls prescribing behaviour more than ever before. Communication between healthcare providers consequently assumes a vital role. If messages are to be coherent and transferable, it is increasingly important that healthcare workers communicate effectively with one another regarding patients, prescribing patterns, and drug tolerability issues. [ABSTRACT FROM AUTHOR]

Examines the evidence of an association between laxative use and other drug use based on case control and cross sectional studies. Observation of nursing home patients; Presence of constipating properties in drugs used; Implication of high constipation prevalence in patients for drug effects.

It is a major clinical and public health problem that there is no clear strategy as to how we best make use of information obtained when pregnant women take drugs. For this reason, some pregnant women are not treated as they should be and some are given drugs they should not use. We suggest a monitoring system that combines some of the available datasets in Europe. Using these sources as a starting point, one can develop a system that has sufficient power to detect even rare diseases like congenital malformations and sufficient diversity to detect several possible outcomes from spontaneous abortions to childhood disorders. We also suggest that case-crossover designs should be used in case-control monitoring systems that carry a high risk of recall bias. These considerations are based upon our results from a European Union-funded concerted action called EuroMaP (Medicine and Pregnancy). [ABSTRACT FROM AUTHOR]