Page 11 - Journal of Special Operations Medicine - Spring 2017

MEDCOM Regulation, No. 40-50, Medical Services

Articles of Interest mosquitoes were previously nuisance pests. However,
they now represent a potential threat in the spread of
Analysis of the Appropriateness of Off-Label Antipsy- viral diseases. The Aedes aegypti, Aedes albopictus, and
chotic Use for Mental Health Indications in a Veteran Culex species mosquitoes are endemic to the United
Population—In this article by JT Painter et al. in Phar- States and together may transmit a variety of viral
macotherapy, the abstract states: “Study Objective: A diseases of growing concern, including West Nile virus,
substantial proportion of antipsychotic (AP) use in vet- chikungunya, dengue fever, and Zika virus. The Cen-
erans is for nonapproved indications (i.e., off-label pre- ters for Disease Control and Prevention (CDC) recom-
scribing). Not all off-label use is necessarily detrimental mend DEET as a first-line mosquito repellent, but for
to patients, however, and in certain situations, off-label patients refusing to use DEET or other conventional re-
prescribing could be considered justifiable. The objec- pellents, guidance is limited to any EPA-registered prod-
tive of this study was to determine the extent to which uct. Therefore, we conducted a systematic review of
off-label AP prescribing in a veteran population was po- the literature to identify which EPA-registered personal
tentially appropriate. . . . Conclusion: The consensus of mosquito repellent provides the best protection from
our expert panel was that off-label AP use is dubious at A. aegypti, A. albopictus, and Culex spp. mosquitoes.
best and more likely, even in complicated cases, inap- We abstracted data from 62 published reports of
propriate. These findings strengthen the case for stron- EPA-registered mosquito repellents. The conventional
ger control of APs in integrated health care settings such repellent picaridin has the strongest data to support
as the VHA, as well as better education and informa- its use as a second-line agent, while IR3535 and oil of
tion for practitioners who provide care for patients with lemon eucalyptus are reasonably effective natural prod-
anxiety, dementia, insomnia, or posttraumatic stress dis- ucts. Citronella, catnip, and 2-undecanone offer limited
order.”2017 Feb 5. doi: 10.1002/phar.1910.
protection or have limited data. These results can be
used by pharmacists and other health care professionals
EPA-Registered Repellents for Mosquitoes Transmit- to advise patients on the selection of an EPA-registered
ting Emerging Viral Disease—Patel RV et al. presents in
Pharmcotherapy: “In many parts of the United States, (continues on page 152)

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