Updates to Depression, Heart Failure: Fluid Retention, Chronic Pain: Trigeminal Neuralgia, and Hyperlipidemia

26 Mar Updates to Depression, Heart Failure: Fluid Retention, Chronic Pain: Trigeminal Neuralgia, and Hyperlipidemia

All TreatGx users now have access to the updated treatment algorithms for Depression, Heart Failure – Fluid Retention, Chronic Pain – Trigeminal Neuralgia, and Hyperlipidemia. 

Depression 

In light of its recent approval in Canada and the US, esketamine nasal spray (Spravato) has been added to the Depression Augmentation/Adjunctive therapy options. Highlights include: 

• Approved by Health Canada for adjunctive use with an SSRI or SNRI in patients who have not responded adequately to at least 2 adequate separate courses of different antidepressants for the current moderate-severe depressive episode.  
• Approved by the FDA for adjunctive use with an oral antidepressant, for treatment-resistant depression, or for major depressive disorder with acute suicidal ideation or behavior.  
• TreatGx provides general information on the use and safety of esketamine, without providing specific dosing, as this should be determined at the treatment site per procedures. 
• Esketamine nasal spray must be administered under supervision at approved treatment centers in order to monitor blood pressure and other side effects. High cost and limited accessibility may limit its use. 
• Based on a 2020 meta-analysis, esketamine intranasal has a Number Needed to Treat (NNT) of 6 for response and an NNT of 7 for remission, at 4 weeks vs. placebo for use as an adjunct in treatment-resistant depression. [1]
  

Heart Failure – Fluid Retention 

The Heart Failure – Fluid Retention algorithm has been updated to include the latest recommendations and information from North American and European guidelines. Therapeutic notes have been added for loop diuretic dosing, and all drugs have been updated to reflect the most current guideline and monograph recommendations.   

Chronic Pain – Trigeminal Neuralgia 

The updated algorithm for Chronic Pain – Trigeminal Neuralgia now includes gabapentin and Botulinum toxin A as additional options. The latest European guideline has been reviewed [2], and all drugs have been updated to reflect the most current guideline and monograph recommendations. 

Hyperlipidemia 

The Hyperlipidemia algorithm has been updated to add a greater range of statin choices, as well as giving specific target doses for both high-intensity and moderate-intensity statin dosing.  

Other highlights of this update include additional drug-interaction dosing, and as always, all updates include the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions. 

References 

1. Papakostas GI, Salloum NC, Hock RS, Jha MK, Murrough JW, Mathew SJ, Iosifescu DV, Fava M:Efficacy of Esketamine Augmentation in Major Depressive Disorder: A Meta-Analysis.J Clin Psychiatry 2020, 81(4). 
2. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May Aet al:European Academy of Neurology guideline on trigeminal neuralgia. European journal of neurology 2019, 26(6):831-849.