THREAD: Bring it down safely! ↘️💊

1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics

👉🏾 Full Letter:

#MedEd #medsafety #prescribing #BetterPrescribing Image
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)


#MedEd #ptsafety #BetterPrescribing #prescribing Image
3/6 Gabapentin, pregabalin, duloxetine:

A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)


#MedEd #BetterPrescribing #deprescribing Image
4/6 Watch the Ceiling!👀

For duloxetine, #gabapentin, pregabalin:

@CochraneLibrary systematic reviews on treating chronic neuropathic pain or #fibromyalgia show exceeding “evidence-informed ceiling doses” doesn't↘️ mean pain scores


#MedEd #ptsafety Image
5/6 Dose matters:

Cyclobenzaprine & duloxetine frequently cause anticholinergic effects including dry mouth, accelerated tooth decay, difficulty swallowing due to reduced salivation; delayed stomach emptying & constipation due to ↘️ gut motility

👉🏾 Image
6/6 Therapeutics Letter 134: Finding the lowest effective dose for non-opioid analgesics

See table below on evidence-informed dosing


#MedEd #ptsafety #BetterPrescribing #prescribing Image
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More from @Drug_Evidence

Feb 2
THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices:

2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) 💊

But... not all BP lowering drugs are proven to reduce both morbidity & mortality


#MedEd #prescribing #hypertension
3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments:

#MedEd #prescribing #hypertension
Read 9 tweets
Jan 21
THREAD: #ExercisePrescriptions

1/5 The TI’s Dr. Josh Levin asks:

Clinicians, can you help your patients be more active? 🏃🏾‍♀️🏊🏾‍♂️ 🚶🏾‍♂️

👉🏾Watch Dr. Levin’s recent presentation: 👨🏾‍💻

#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.

👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: 🏊🏾‍♂️🏃🏾‍♀️🚶🏾

#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription 🏊🏾‍♂️🏃🏾‍♀️🚶🏾‍♂️

#Exercise #prescribing #twitterRx #BetterPrescribing
Read 6 tweets
Nov 27, 2021
THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

👉🏽Watch the presentation here: 🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here:🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality

✅Watch @JamisonFalk's presentation here:🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets
Nov 10, 2021
THREAD: Evidence for oseltamivir for #influenza prevention

1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention

✅Flu guidelines

✅Systematic review of Tamiflu safety
2/6 #Oseltamivir for prevention reduces ↘️ symptomatic influenza by 3%, (NNT=33) with an uncertain effect on asymptomatic #influenza

It likely has a central symptom reducing effect but may not reduce viral transmission

#Tamiflu #prescribing
3/6 #Oseltamivir won’t reduce the risk of developing influenza-like illness though it can make people feel better (i.e. fewer symptoms) and reduces ↘️ fever

There is not enough evidence to say it prevents death, hospitalizations, or flu complications
Read 7 tweets
Sep 19, 2021
THREAD: Medication adherence and shared decision-making

1/6 Our TI Letter 132 suggests a more democratic & ethical approach to shared decision-making:

Here are 5⃣ highlights…

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
2/6 Patients always retain right to say “no, thank you”🛑

Some pts may not want to accept their doctor's recommendations for a prescribed 💊 & have their own reasons to feel that it's not worth it for them.

This "intentional non-adherence" is a choice that should be respected
3/6 Studies have tested adherence aids

While these aids can improve adherence we don’t know if they lead to improved health outcomes 😕

See our TI Letter 132 on medication adherence: 💻

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
Read 7 tweets
Jul 12, 2021
THREAD: Shedding light on the risks of anticholinergic drugs

1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th


#MedEd #deprescribing #medsafety
2/8 One of every 14 of the top 200 💊 prescribed in BC has anticholinergic properties

They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...

👉🏽More here…

#MedEd #deprescribing
3/8 What kinds of harms can #anticholingergics cause?
👉🏽Dry mouth 😦

❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔

More here:…

#MedEd #deprescribing
Read 9 tweets

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