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Therapeutics Education Collaboration
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Episode 110: Even more, questions, questions and more questions

In episode 110, in this final episode of the year James and Mike attempt to answer even more questions. They discuss the benefits and harms of using atypical antipsychotics in the elderly and decide that ‘microdoses’ is the correct answer. They get into a heated debate on the issue of the interaction with PPIs and clopidogrel and at the end both agree on the answer which is “Yes, but only on a Tuesday”. We finish off with a rousing discussion on the grapefruit/felodipine interaction and realise that neither of us like grapefruit so who cares. We both wish you and your family a Happy Holidays.

Show notes

1) Data on benefit

Psychother Psychosom 2007;76:213-8

Cochrane Library 2006:CD003476

2) Data on harm

Atypical meta-analysis (of trials not designed to assess harm)

JAMA 2005;294:1934-43

Cohort of conventional vs atypical

NEJM 2005;353:2335-41

CMAJ 2007;176:627-32

3) Actual RCT to assess risk benefit of withdrawal of antipsychotics

Lancet Neurol 2009;8:151–57

PLoS Med 5(4): e76.doi:10.1371/journal.pmed.0050076

4) One page summary of risks/benefits of anti-psychotics:

See Tools for Practice Website: http://www.acfp.ca/tfp_original.php

Specific reference: http://www.acfp.ca/docs10/Antipsychotics%20in%20Elderly%20_2_.pdf

5) Clopidogrel and PPI’s
CMAJ 2009;180:713-8
JAMA 2009;301:937-44
Lancet 2009; 374:989–97
Circulation 2009;120:2322-9
Ann Intern Med 2010;152:337-45
http://www.theheart.org/article/1007145.do
Circulation 2009;120;2310-2
Am J Gastroenterol 2010;105:2430–6

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