Releases Saturday 23 October 1999
No 7217 Volume 319
Please remember to credit the BMJ as source when publicising
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(1)SOME ANTIDEPRESANTS INCREASE THE RISK OF
GASTROINTESTINAL BLEEDING - ESPECIALLY
WHEN TAKEN WITH NSAIDs OR ASPIRIN
(2)GREATER AWARENESS
OF CARBON MONOXIDE
POISONING NEEDED
AMONG PATIENTS AND
DOCTORS
(1)SOME ANTIDEPRESANTS
INCREASE THE RISK OF
GASTROINTESTINAL BLEEDING - ESPECIALLY
WHEN TAKEN WITH NSAIDs OR ASPIRIN
(Association between selective serotonin
reuptake inhibitors
and upper gastrointestinal bleeding:
population based
case-control study)
http://www.bmj.com/cgi/content/full/319/7217/1106
(Antidepressants and upper gastrointestinal
bleeding)
http://www.bmj.com/cgi/content/full/319/7217/1081
People taking selective serotonin reuptake
inhibitors (a type
of antidepressant) have an increased risk
of upper
gastrointestinal bleeding, claim researchers
from Spain in this
week's BMJ. Although the risk is three
times greater than
those not taking antidepressants, in absolute
terms the risk is
moderate (estimated to affect one person
in 8,000 taking
antidepressants), say the authors.
Dr Francisco Jos de Abajo and colleagues
from Madrid
studied 1651 people who had suffered upper
gastrointestinal
bleeding (cases) and compared them to
a control group of
10,000 who did not have upper gastrointestinal
bleeding.
They found that 3.1 per cent of case patients
had been
taking selective SRIs as opposed to only
one per cent in the
control group.
The risk is similar to that of low dose
ibuprofen, say the
authors but their study suggests that
when selective SRIs are
taken with non-steroidal anti-inflammatory
drugs (NSAIDs)
or aspirin, the risk of bleeding is greatly
increased. They say
that this finding may have important public
health implications
owing to the high prevalence of both antidepressants
and
NSAIDs in most developed countries.
In a linked editorial Professor Alain Li
Wan Po, from the
Centre for Evidence-Based Pharmacotherapy
at Aston
University in Birmingham, writes that
further studies are
needed to confirm the results of de Abajo
et al's study. He
argues that the term "serotonin reuptake
inhibitor" is not well
defined in the paper and that this could
cause confusion
when interpreting de Abajo et al's findings.
However, Li
Wan Po advises prescribers that although
there may be
alternative explanations other than the
drug for the observed
increase in risk of gastrointestinal bleeding
"..greater caution
is probably warranted in co-administering
non-steroidal
anti-inflammatory drugs and serotonin
reuptake inhibitors."
Contact:
Dr Francisco Jos de Abajo, Head, Divisin
de
Farmacoepidemiologa y Farmacovigilancia,
Agencia
Espaola del Medicamento, Madrid, Spain
Email: fabajo{at}agemed.es
Professor Alain Li Wan Po, Director, Centre
for
Evidence-Baed Pahrmacotherapy, School
of Life and
Health Sciences, Aston University, Birmingham
Email: a.liwanpo{at}aston.ac.uk
(2)GREATER AWARENESS
OF CARBON MONOXIDE
POISONING NEEDED AMONG PATIENTS AND
DOCTORS
(Carbon monoxide poisoning)
http://www.bmj.com/cgi/content/full/319/7217/1082
As the UK sees the onset of Autumn and
the cooler weather
that it brings, the numbers of unintentional
deaths from
carbon monoxide poisoning begin to rise,
write Dr Ed
Walker from Dewsbury District Hospital
and Dr Alastair
Hay from the University of Leeds in this
week's BMJ. The
authors explain the difficulties of diagnosing
carbon
monoxide poisoning and comment that the
most tragic
consequence of a missed diagnosis is that
patients may be
discharged to the very environment that
is poisoning them.
Each year around fifty people in the UK
die from carbon
monoxide poisoning, however as many as
25,000 people
may be exposed to the effects of carbon
monoxide in the
home, write Walker and Hay. The early
symptoms of this
type of poisoning are usually said to
be flu like, they say,
which makes diagnosis difficult, especially
when more than
one member of the same household exhibits
similar
symptoms, indicating a microbial cause.
They report that
"symptoms may initially be mild, often
include
gastrointestinal upset in children and
usually are associated
with the occupancy of a particular building
or room" with
several family members (including pets)
affected.
Testing for carbon monoxide in the blood
(carboxyhaemoglobin) is straightforward
and will pick up
exposure in its early stages, say Walker
and Hay and breath
meters (originally developed as smoking
cessation aids) are
now available- but "most of the time,
no one thinks to do the
test."
The authors conclude that "with a simple,
non-invasive
testing device the chances of such tragedies
could be
dramatically lessened. But to achieve
this we must also see
increased awareness of the problem, among
patients and
their doctors."
Contact:
Dr Ed Walker, Staff Grade Practitioner,
Accident and
Emergency Department, Dewsbury District
Hospital,
Dewsbury
Email: ed{at}limeland.demon.co.uk
FOR ACCREDITED JOURNALISTS
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BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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