Keeping women overdosed

Sex matters as much as gender. Sex differences still have an impact on the health of our populations. Despite an increased enrolment of women and the beginnings of understanding sex differences, very little has moved to explore these issues in the last three decades. Most clinical studies still do not include sex-specific analyses.

It’s enough to keep any woman awake at night

For decades we have known that drug therapies prescribed to men-born-men and women-born-women often differ, in their absorption, utilisation and excretion between the two groups. Unfortunately, prescribing decisions are not always aligned with this kind of evidence. For example, despite hundreds of robust studies identifying specific sex differences in metabolism between men and women, women are more likely to be prescribed sex-sensitive medications for the management of a range of conditions, including migraine, thyroid disorders, depression, and sleeping problems. 
The pursuit of the influence of sex/gender on the impact of prescribed pharmaceuticals has been at best, sporadic and certainly not systematic. Over two decades ago, many sex specific dangerous drugs that were identified. Of these drugs, which were identified to be removed from the USA market, only eight drugs were finally withdrawn due to greater risks to women than men. After being on the market for more than 20 years, one drug, zolpidem,  a drug widely used for insomnia, received a warning to decease the dosage for women by half. in 2011, in the USA, about 39 million prescriptions of zolpidem were dispensed nationally and 63% of these were to women.  Data, that had been around for some time, showed that the risk of next-morning drowsiness from zolpidem—enough to impair driving ability—was greater in women than in men receiving the same doses.  
Fortunately, vigilance hasn’t been left to the health care professions. As with other areas, women are taking it upon themselves to be more aware of harmful medications. For example, women are more likely than men to initiate a conversation with a health care provider about stopping medications than their male counterparts.  Satin treatment for high cholesterol is one example. Statins were found to be discontinued earlier in women suffering from advanced cancer, on their insistence, than in men suffering from the same conditions. This behaviour was in line with much earlier, neglected studies showing that statin discontinuation in palliative care patients does not affect mortality or cardiovascular events.
With the advent of electronic prescribing, one would think that the large datasets would allow for the development of algorithms  which could enable safer prescribing across all patient groups, races, and genders. Unfortunately, that is not the case. Of the 20 top tools used to identify inappropriate prescribing and deprescribing worldwide, none has a feature to address sex differences.

It’s enough to keep any woman awake at night.

One thought on “Keeping women overdosed

  1. Interesting. The computer system I use in primary care in the UK automatically suggests a dose of 3.75mg for zolpidem in women (but I hardly ever prescribe sedatives). Thyroid replacement I titrate according to symptoms, with an eye on TSH results, regardless of sex. Similarly, I titrate migraine treatment according to lowest effective dose, again regardless of sex. Women may be more likely to discuss coming off medication with their GP, but my impression is that men are more likely to stop taking medication without telling their GP.


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