Eli Marom

Trends in attention deficit hyperactivity disorder drugs consumption, Israel, 2005–2012

The aim of this study was to describe trends in attention deficit hyperactivity disorder (ADHD) drugs consumption in Israel (Ritalin, Concerta, Daytrana, Vyvanse, Focalin, and Adderall) over the 8 years, 2005–2012, and to explore explanations for changes in amounts and patterns of the utilization.

Utilization of antiepileptic drugs in Israel

PURPOSE The aim of the study was to identify trends in utilization of antiepileptic drugs (AEDs) over time in a nation-wide population in Israel. METHODS Data on AED utilization (for all indications) for the period 2010-2014 were obtained from pharmaceutical companies that distribute AEDs in Israel. Prevalence of AED utilization was reported as defined daily doses (DDD)/1000 inhabitants/day. RESULTS The utilization of most AEDs included in our analysis remained stable over the study period. The greatest increases in utilization of drugs established in Israel were observed for lamotrigine (33%), oxcarbazepine (31%), and primidone (18%). Decreases in use were recorded for carbamazepine (18%) and phenobarbital (15%). Use of older AEDs appeared to be relatively high, compared with the use of newer AEDs. CONCLUSIONS During the study period of 2010-2014, conventional AEDs remained a main treatment choice in Israel, in certain cases in contrast to current recommendations and guidelines, for reasons yet to be revealed in further research.

Causative Drugs of Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis in Israel

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are T-cell-mediated skin eruptions that are part of a broader category known as severe cutaneous adverse drug reactions (SCAR). SJS involves less than 10%of the body surface area, whereas skin detachment in TEN is more severe and involves 30% of the body surface area. Skin detachment that falls between 10% and 30% is described as SJS-TEN overlap.1 SJS and TEN are rare syndromes, with an estimated incidence at 1 to 2 cases per 1 million inhabitants per year in European countries.2 However, these conditions may lead to mortality or severe disability of previously healthy people and have prompted the withdrawal of newly released drugs3. Drugs highly suspected to cause SJS/TEN include allopurinol, aromatic anticonvulsants (carbamazepine, phenobarbital, phenytoin, and lamotrigine), nevirapine, sulfonamides, and oxicam-NSAIDs. Weaker associations have been additionally found for paracetamol, aminopenicillins, cephalosporins, and quinolones.2,4 Although hypersensitivity reactions have been considered as “type B” or dose-independent reactions, accumulating evidence suggests that the risk may be greater with high doses and rapid dose escalation, at least for allopurinol and lamotrigine.5–7 The propensity to develop SJS and TEN varies across populations of different ethnicities. The most prominent example is the strong association between carbamazepine-induced SJS/TEN and the presence of the human leukocyte antigen (HLA) allele B*15:02 in individuals of Han Chinese and other Southeast Asian origin8 but not in Northern Europeans.9 In the latter population10 and in patients of Japanese origin,11 carbamazepine-induced cutaneous adverse reactions have been linked to another HLA allele, A*31:01. This information has been translated into an FDA boxed warning that requires screening for HLA-B*15:02 in patients of high-risk ethnic origin and a warning for HLA-A*31:01.12 Likewise, the association between HLA-B*58:01 and allopurinol-induced SCAR is strong in patients of Asian origin13 but is weaker in white populations in Europe, in which HLA-B*58:01 is also much less prevalent than in Han Chinese.14–16 The variability among ethnic groups may also apply to Israeli populations. For instance, we have recently shown that

Genetic risk factors for antiepileptic drug–induced hypersensitivity reactions in Israeli populations

The human leukocyte antigen (HLA) alleles B*15:02 and A*31:01 have been identified as predictive markers of adverse cutaneous effects of carbamazepine and phenytoin in Asian and North European populations, respectively. Our aim was to estimate the distribution of these alleles in Jewish and Arab populations in Israel. The HLA‐B*15:02 and HLA‐A*31:01 carrier rate was estimated based on data from the Hadassah Bone Marrow Registry. Data on Stevens‐Johnson syndrome (SJS)– and toxic epidermal necrolysis (TEN)–related hospitalizations were obtained from the Israeli Ministry of Health (MOH) registries and from four Israeli medical centers. Of 83,705 Jewish and Arab‐Muslim donors, 81 individuals of known origin carried the HLA‐B*15:02. Among them, 66 were Jews of India‐Cochin descent. Of the Cochin Jewish donors, 12.7% were B*15:02 carriers. HLA‐A*31:01 carrier incidence among Arab and Jewish Israeli populations (3.5% and 2.2%, respectively) was within the range reported in other countries. We did not identify SJS‐ or TEN‐related hospitalizations of Jews of Indian descent. Yet, this population should be considered at greater risk for antiepileptic drug–induced SJS and TEN. Until further data on actual risk are available, such patients should be typed for HLA‐B before treatment with carbamazepine or phenytoin.

Pharmacy in Israel

Israel is a small country located at the juncture of 3 continents (Africa, Asia, and Europe). With a population of just over 8 million and an area of just over 22,000 km2, Israel had a population density of 373 persons/km2 in 2015.[1][1] The state is a democracy with a parliamentary, multiparty

Trends in utilization of benzodiazepine and Z-drugs in Israel

Studies on benzodiazepine (BZDs) as well as Zopiclone and Zolpidem (Z‐drugs) utilization are important for estimating the prevalence of medical conditions, providing the basis for pharmacovigilance, and identifying temporal trends of consumption. Such studies that involve the Israeli population have not been conducted yet.

Strategies for patient empowerment through the promotion of medicines in Israel: regulatory framework for the pharmaceutical industry

The correct and rational use of medications can have a positive direct impact on disease outcomes, as well on the utilization of the health system resources. Unfortunately, 50% of the patients do not take their medications as prescribed, largely due to lack of patients’ understanding of their medical condition, as well as the lack of reliable medicine information.There are multiple strategies implemented in many countries to tackle this challenge including: disease awareness campaigns (DAC) to raise the public awareness to specific diseases, direct-to-consumer advertisement (DTCA) to raise the public awareness to prescription medicines, specific treatments and over-the-counter (OTC) products to improve the accessibility of patients to specific medicines.Prior to 2013, the Israeli policy prohibited prescribing medication advertising and prevented the flow of information from pharmaceutical companies to the patient. In the last five years, the Pharmaceutical division in the Israeli Ministry of Health, as part of the “empowering the patient” agenda, has taken new innovative approaches to raise public awareness to diseases, medications and appropriate usage, as well as promotion of information to improve patient adherence to the prescribed medication.This paper elaborates on the aforementioned strategies implemented in developed countries, and specifically focuses on newly implemented strategies and regulations in Israel regarding pre- and post-prescription information, to improve patient appropriate utilization and adherence to medication.

Changes in consumption of opioid analgesics in Israel 2009 to 2016: An update focusing on oxycodone and fentanyl formulations

The purpose of the study is to assess opioid (morphine, methadone, oxycodone, pethidine, and fentanyl) consumption in Israel during 2009 to 2016 and identify recent trends.

Clinical and other specialty services offered by pharmacists in the community: the international arena and Israel

The community pharmacy setting is a venue that is readily accessible to the public. In addition, it is staffed by a pharmacist, who is a healthcare provider, trained and capable of delivering comprehensive pharmaceutical care. As such, community pharmacists have a colossal opportunity to serve as key contributors to patients’ health by ensuring appropriate use of medications, preventing medication misadventures, identifying drug-therapy needs, as well as by being involved in disease management, screening, and prevention programs. This unique position gives the pharmacist the privilege and duty to serve patients in roles other than solely that of the stereotypical drug dispenser.Worldwide, as well as in Israel, pharmacists already offer a variety of pharmaceutical services and tend to patients’ and the healthcare system’s needs. This article provides examples of professional, clinical or other specialty services offered by community pharmacists around the world and in Israel and describes these interventions as well as the evidence for their efficacy. Examples of such activities which were recently introduced to the Israeli pharmacy landscape due to legislative changes which expanded the pharmacist’s scope of practice include emergency supply of medications, pharmacists prescribing, and influenza vaccination. Despite the progress already made, further expansion of these opportunities is warranted but challenging. Independent prescribing, as practiced in the United Kingdom or collaborative drug therapy management programs, as practiced in the United States, expansion of vaccination programs, or wide-spread recognition and reimbursement for medication therapy management (MTM) programs are unrealized opportunities. Obstacles such as time constraints, lack of financial incentives, inadequate facilities and technology, and lack of professional buy-in, and suggested means for overcoming these challenges are also discussed.