Statement on Prevention of Adolescent Suicide

Addressing the threefold increase in suicide in adolescents over the past 40 years, the American College of Obstetricians and Gynecologists has released a committee opinion on the prevention of adolescent suicide (ACOG Committee Opinion No. 190). The statement discusses methods of suicide, risk factors in adolescents, risk assessment and prevention.

Because adolescents contemplating suicide rarely tell their physicians, ACOG recommends that physicians approach the subject as part of background questioning about family, school and relationships. Two examples of the questions that ACOG suggests are “Sometimes patients I've seen dealing with similar issues/problems get very down and start to question life itself. Does this happen to you?” and “Have you every thought about suicide?” These questions should be asked in a non-threatening and non-judgmental way. If the patient responds affirmatively to the questions, further assessment of risk factors is necessary.

ACOG believes that physicians play an important role in addressing the problem of adolescent suicide. Physicians should be prepared to assess suicide risk and, when necessary, provide immediate counseling or referral.

More information about ACOG committee opinions, technical bulletins and practice patterns can be obtained from ACOG, 409 12 St., S.W., Washington D.C. 20024; telephone: 800-762-2264.

Opioid-Ibuprofen Tablet for Acute Pain

A combination tablet with 7.5 mg of hydrocodone bitartrate and 200 mg of ibuprofen (Vicoprofen) has been approved by the U.S. Food and Drug Administration for the treatment of acute pain. This is the first opioidibuprofen combination tablet indicated for acute pain.

Results of clinical trials reported by the manufacturer show that the combination tablet relieved acute pain in a broad range of applications including postsurgical or dental pain and pain related to sprains/strains, back disorders, sport injuries and fractures/dislocation. The most common side effects were nausea, sleepiness, dizziness, headache, constipation and dyspepsia.

Vicoprofen should not be prescribed to patients in whom aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) induce asthma, urticaria or other allergic-type reactions. Serious gastrointestinal toxicity, such as inflammation, bleeding, ulceration and perforation of the stomach, small intestine or large intestine, can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. As with any opioid analgesic, the usual precautions should be taken regarding the impairment of mental and/or physical ability.

Noise-Induced Hearing Loss in Fetuses and Infants

Fetuses and newborns exposed to excessive noise may have noise-induced hearing loss and other health problems, such as prematurity and intrauterine growth retardation, according to a statement published by the Committee on Environmental Health of the American Academy of Pediatrics (AAP) in the October 1997 issue of Pediatrics. In addition, exposure of newborns to noise in the neonatal intensive care unit may result in cochlear damage, and exposure to noise and to other environmental factors in the neonatal intensive care unit may disrupt the normal growth pattern and development of premature infants.

The AAP committee arrived at these conclusions after reviewing evidence collected since 1974 on this subject. In one study reported in the statement, children determined to have high-frequency hearing loss at four to 10 years of age were more likely to have been born to women who were exposed consistently to occupational noise in the range of 85 to 95 decibels during pregnancy. The committee encourages physicians to consider screening infants who were exposed to excessive noise during pregnancy or as newborns for noise-induced hearing loss. The AAP also encourages physicians to monitor sound levels in the neonatal intensive care unit and within incubators. A noise level of more than 45 decibels is a concern.

The AAP recommends further research on the effects of noise exposure during pregnancy and believes that the Occupation Safety and Health Administration should consider pregnancy when it sets its standards on occupational noise.

Tazarotene Gel for Psoriasis and Acne

Topical tazarotene gel (Tazorac) has been approved by the U.S. Food and Drug Administration for the treatment of stable plaque psoriasis involving up to 20 percent of the body surface area and mild to moderate facial acne vulgaris. The topical gel will be available in two strengths, 0.05 percent and 0.10 percent.

Tazarotene is the first of a new generation of topical, receptor-selective retinoids. Retinoids are synthetic analogs of vitamin A.

In clinical trials involving 1,400 patients with plaque psoriasis, tazarotene gel, applied once daily, has shown global treatment success rates of up to 65 percent in patients using the 0.10 percent gel and up to 52 percent in patients using 0.05 percent gel, compared with a rate of 33 percent in patients using the control vehicle. Global success was defined as the percentage of patients with a good or excellent response or complete clearing (50 percent improvement or more), based on the physician's assessment.

Tazarotene gel appears to be well tolerated. The majority of adverse effects, which occurred in 10 to 30 percent of subjects in the trials, were mild to moderate and dose-related and consisted of itching, burning/stinging, erythema, worsening of psoriasis, irritation and skin pain.

The drug is not recommended for use in women who are pregnant or may become pregnant during treatment. Women with childbearing potential must use adequate birth control measures if they use the gel.