Majority of doctors unaware of Black Box warnings on drugs they prescribe - we can't rely on them for info, have to educate ourselves

[Mary]

https://www.msn.com/en-us/health/ot...S&cvid=921b9f53d1864136b8dcf3da904c7b96&ei=45

I should have posted the title of the above article with a hyperlink, like this:

New York AG asks FDA to double down on warnings, discourage prescription for asthma drug​

Here's why the NY AG wants the FDA to do more re this dangerous asthma drug:

[AG] Srinivasan noted that it “has been nearly four years since” the FDA “strengthened existing warnings regarding the mental and behavioral health side effects of asthma and allergy drug montelukast (brand name Singulair) by imposing a black box warning, the strictest and most serious warning given to medications.”

Srinivasan said since the decision, “the prevalence of tragic adverse mental health events” like depression and suicide are still “widely reported and disproportionately so for pediatric patients.”

Srinivasan called the black box warning “insufficient” and implored the federal agency to “take immediate action to prevent further unnecessary health risk to patients in our State related to the use of montelukast” via measures like “issuing a new Drug Safety Communication stating that the FDA is evaluating the risks of using montelukast in children under the age of 18 for asthma and allergic rhinitis.”

I knew doctors generally ignore black box warnings (in my experience at least), e.g., wanting to give me Cipro twice for simple UTIs. They have a list they're supposed to follow and Cipro was at the top - how much did Cipro's maker have to pay to get to the top of that list?

And more on black box warnings and their ineffectiveness - they're only as effective as doctors' and patients knowledge about them, and their willingness to act or not act:

Recognition and Knowledge of Medications with Black Box Warnings Among Pediatricians and Emergency Physicians​

Only 19/50 (37 %) EM physicians and 16/31 (52 %) Peds reported that they consider BW when prescribing medications.

https://www.drugwatch.com/fda/black-box-warnings/

A 2005 study by Dr. Anita Wagner and colleagues published in Pharmacoepidemiology and Drug Safety revealed that the range of compliance with black box warnings among doctors varied from 0.3 to 49.6 percent.

 

[BrightCandle]

I have seen it all. I have seen them under and over dose drugs. I have seen doctors and pharmacists miss dangerous interactions and also just not warn me about common problems.

Any drug you are prescribed you need to check it for interactions online and go through the paper they ship with it and quite likely also check any other prescription meds paper too incase it lists that drug too. No one in healthcare is going to be bothered to do this for you so its a necessary step of adding any new drug.

 

[Gondwanaland]

Additionally, I strongly recommend to anyone considering to take medications, herbs or supplements to check their levels of fasting bilirubin first. If any one or more than one of the markers (total bilirubin, unconjugated bilirubin, conjugated bilirubin) is slightly elevated or at the top end of the range, BEWARE of drugs and "healthy" flavonoids!

 

[Violeta]

This is so true and important, @Mary!

That's interesting, @Gondwanaland, I have never heard that about bilirubin and medications, herbs, or supplements.

 

[Blazer95]

I developed a minor Serotonin Syndrome Like issue with diarrhea, dizzyness, shivers and Panic attacks because i took Citalopram with Curcuma.

Spoiler: Nobody told me what a MAO-INHIBTOR is that Curcuma is a pretty potent one.

Tldr: read everything

 

[Viala]

A pharmacist should know all these things and inform if there are any warnings or dangerous interactions. Yet a doctor has more knowledge and should know it too, not to prescribe drugs like candies and never worry about anything or never warn a patient what they could expect.

I think a lot of them are reckless because they're desensitized and simply do not care, they care about money. They're trained to believe that most drugs are safe and that rarely anything goes wrong, it's all FDA approved after all. It is easier to think about it as a business model where a doc is a businessman selling drugs, so they will not work against their 'employers' and badmouth their products, so why to learn more about them? The more side effects, the more other pills will be sold. These people stopped working for us a long time ago.

 

[Gondwanaland]

This is so true and important, @Mary!

That's interesting, @Gondwanaland, I have never heard that about bilirubin and medications, herbs, or supplements.

High bilirubins mean impaired xenobiotic detoxification!
Some conditions upstream to it are (heterozygous from the X chromosome) deletions in the genes G6PD and GST, that may lead to and/or be associated with (autossomal homozygous) Gilbert's and Rotor's syndromes (heterozygosity also has an impact).

There are long lists of substances harmful to people with these conditions. These conditions will only get some attention from a health care provider after severe side effects and autossomal heterozygosity receives no attention at all.

 

[Gondwanaland]

For instance:

https://www.healthline.com/nutrition/g6pd-deficiency-foods-and-supplements-to-choose-and-avoid

People can live over 50 years and never know about their condition, which can be suddenly aggravated by an infection or injury. If they do not present with anemia, the health professional will never suspect G6PD or GST genetic dysfunction.