Boosting Plan B with an NSAID

Taking levonorgestrel (aka Plan B) to prevent unwanted pregnancy is effective … but not 100% effective. A way to get it closer to that 100% mark might be to add piroxicam (aka Feldene).

A group of researchers from Hong Kong and Sweden found that, by blocking prostaglandin production, piroxicam makes levonorgestrel significantly more effective, especially if the Plan B is taken later rather than sooner.

The results showed that the percentage of pregnancies prevented by piroxicam-levonorgestrel co-treatment (94.7%) was significantly higher than that of the levonorgestrel emergency contraceptive pill alone (63.4%).

Benzos may not be that effective

“I love you. I love you on Xanax more.” But benzos might not be as effective as everyone’s been led to believe. That’s the conclusion of researchers at Oregon Health and Sciences University that crunched the data from five FDA-reviewed, phase 2 and 3 studies of alprazolam (aka Xanax XR).

Of the five trials the FDA reviewed, get this: Only three were published in medical journals, and only one (!) showed clearly positive results.

Using meta-analysis […] they found that alprazolam extended-release was still superior to a placebo, but not as much as the published data had conveyed. Specifically, they found that publication bias inflated the drug’s efficacy by more than 40%.

As the senior author put it, “Our study throws some cold water on the efficacy of this drug. It shows it may be less effective than people have assumed.” [But … well, insert something about the placebo effect here.]

Clearing up some compounding confusion

News stories keep appearing about how the companies selling new weight loss drugs are suing to prevent compounding pharmacies and others from dispensing their own versions. But so many news sources don’t seem to get it.

Currently it’s probably^* legal to sell compounded versions of semaglutide, no matter what the brand-name companies (Lilly, Novo, etc.) say. The FDA is clear: Drugs in shortage can be compounded.

Compounded meds are not individually FDA-approved. Never have been. The active ingredients, though, are. So saying, “The FDA does not review the products for safety, quality, or efficacy” is misleading and designed as a scare tactic.

That said, is illegal to call those meds “Ozempic” or “Mounjaro” or whatever — but that’s a trademark issue. It’s also not legal to sell them without a prescription. Duh.

What’s happening is that drug companies are trying to confuse these issues to make it sound as if semaglutide compounded by legitimate compounding pharmacies is illegal and otherwise a Bad Thing. It’s not.

Take this sentence from a Fierce Pharma article:

In September, Eli Lilly filed lawsuits against eight companies in the U.S. that it claims are producing or selling compounded versions of its blockbuster diabetes drug Mounjaro.

The word “claims” makes it sound like compounding is bad or illegal. (“Smith Claims Jones is Wearing Shoes Made in Indiana” makes it sound as if there’s something shameful about Indiana shoes.) So when you see “Company X is suing over unauthorized versions of its drugs,” read the details, and don’t fall for this stuff.

^* I’m not a lawyer so I’m not going to say that with certainty, but the folks at the Alliance for Pharmacy Compounding have a PDF explainer.

CVS pulls phenylephrine

Not waiting for the FDA to remove phenylephrine products from the market, CVS said it’s yanking decongestants that use it from store shelves. Of note: It’s only removing decongestant-only products like Sudafed PE, not other meds that contain phenylephrine … yet.

When vape bans backfire

The idea sounded good: Ban flavored e-cigarettes to reduce the appeal to people, especially minors. But it may be backfiring and driving them to a worse option: traditional cigarettes.

An analysis out of Yale of vape policies and sales data over 5 years found that…

During the study period, hundreds of localities and seven states restricted or prohibited flavored e-cigarette sales. While these policies did reduce per-capita vape sales, they also substantially boosted cigarette sales.

For each 0.7 milliliters of e-cigarette e-liquid not sold due to these policies, the authors calculated that 15 additional cigarettes were purchased.

What’s not clear is why people would opt for tobacco — which is obviously a lot worse for you — than for unflavored vapes. (With 71% of the cigarette sales bump for non-menthol varieties, it’s not the flavor. Maybe they just figure life isn’t worth living without flavored vapes.

Post-joint-replacement antibiotics: one and done

It’s become common after replacing a knee or hip to give patients vancomycin to prevent MRSA infection — after giving them cefazolin during surgery. That might not be a good idea.

Aussie researchers found that not only was adding vancomycin to post-surgery treatment not any better, it might even be worse:

Unexpectedly, in patients undergoing knee joint replacement, the risk of infection was higher in the group that had the added vancomycin, at almost 6%, than in the placebo group, with a roughly 4% infection rate.

Quick take

“People who eat just two servings of red meat per week may have an increased risk of developing type 2 diabetes” according to a study out of Harvard.