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The Diabetes Drug and Gangrene Scare

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August 2018 the Food and Drug Administration alerted diabetic patients of the dangers of the SGLT2 inhibitor medications for a specific type of gangrene. This is not just one drug but a class of medications. The condition, commonly called genital gangrene, is serious and can even be fatal.

SGLT2 Inhibitors

This type of drug is used to treat type 2 diabetes, but it has also seen some effectiveness in type 1 diabetes. Type 2 diabetes results in a high blood glucose level because the body cannot use the insulin up. It’s most common in middle-aged adults and seniors, but it can occur in other ages as well. This type of diabetes is known as hyperglycemia and is the most common form.

SGLT2 inhibitors work by moving the excess insulin out of the body through the kidneys and in the urine. They work in conjunction with diet and exercise to help the person be able to regulate their glucose levels.

Medications are used to control the diabetes unless the condition is too severe and requires other treatments. Since diabetes drugs are the most common form of treatment, it’s important for patients to understand the risks.

Gangrene and Diabetes

The type of gangrene the FDA warns of with the SGLT2 inhibitors is called Fournier’s gangrene or genital gangrene and is necrotizing fasciitis. It is a rare form of gangrene that only affects the genital areas of patients, mostly men.

In fact, most of the people diagnosed with this condition have been males between 50 and 70 years of age. It affects 1.6 men out of 100,000 each year, which shows how rare it is even for diabetics. A total of 1.7 million people received prescriptions for SGLT2 inhibitors in 2017.

To develop this condition, bacteria must enter a cut in the body. The bacteria then attack the tissue under the skin around the genital area. It causes an infection in the tissue and swelling or tenderness and redness around the genitals. If left untreated, it can cause a severe infection and loss of tissue as well as death.

The Link Between Genital Gangrene and Diabetes Medications

Studies indicate that taking the SGLT2 inhibitors can increase the risk for developing this condition. Between 2013 and 2018, 12 people were diagnosed with the condition, five of which were women. It’s extremely rare for a woman to develop this type of gangrene and at double the normal rate.

Anyone with diabetes is at a greater risk for developing gangrene than someone who doesn’t have the condition because of limited circulation and reduced blood flow. With the addition of the medication, the risk goes up even more.

The drug increases the amount of glucose in the urine, which helps to feed any infection in the body. It can slow down the healing process even if the cut is small. This allows the bacteria to continue to grow and develop into a serious situation.

Supporters of the medications say that 12 cases indicate a minimal risk for those who rely on the drugs to help them control their glucose levels. However, the FDA now requires manufacturers of these drugs to label them with the new warning. This ensures that they are aware of the risk if they choose to take the medication.

Of those 12 who were diagnosed with Fournier’s gangrene, one person died. Four others suffered various complications from the condition and all needed multiple surgeries to remove the dead tissue.

While genital gangrene is certainly one of the most serious results of taking these SGLT2 inhibitors, it is by no means the only risk. Anytime a medication causes additional glucose to move through the kidneys and urine, it puts the person at risk for other infections, such as urinary tract infections. Because diabetics heal at a slower rate in many cases, they can develop other complications and have a more severe reaction to the symptoms.

Anyone who is taking SGLT2 inhibitors should talk to their doctors about the risks and potential side effects. They not only need to know about genital gangrene but other conditions. They need to ask their doctor what symptoms to look for and what to do if they notice signs of problems.

While these inhibitors have shown some positive results for diabetics who are trying to control their type 2 diabetes, they do not come without some level of risk. Many patients may be able to take the drugs with no concerns, but they need to be aware of those risks and make an informed choice.

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Dangerous Medications

Interstitial Cystitis Patient Suffers Progressive Visual Deterioration from Elmiron Treatment

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After being treated for bladder pain syndrome with pentosan polysulfate sodium (sold under the brand name Elmiron) for two years, a woman in Texas says she experienced progressive vision problems that eventually led to blindness.

According to court filings, the patient began taking Elmiron in 1997 and less than two years later began to experience blurred vision and having trouble with her eyes adjusting in dim lighting. In 2002, she was diagnosed with maculopathy. Additional medical notes showed that pigment changes were also present on the macula of both eyes.

Unfortunately, in 2010, doctors determined the patient was legally blind from macular degeneration and in 2013, she was further diagnosed the eye disease pigmentary retina dystrophy, which is typically characterized by colored spots on the retina.

Elmiron Research Warns of Potential Eye Damage Complications

The patient and her physicians did not know that Elmiron could cause vision damage, as there were no warnings indicating adverse vision events and the first major study connecting the bladder pain drug to vision damage wasn’t published until 2018.

In that study, published in 2018 in the Journal of Urology physicians from the Emery Eye Center noted eye damage and vision problems in six patients who had been treated with Elmiron. More studies followed regarding the association between eye damage and use of Elmiron.

Elmiron Warning Label Changes Delayed in the U.S.

In 2019, the European Medicines Agency required Elmiron maker Janssen to update the label to warn of the potential for eye damage. Health Canada required the same warning label update later the same year. However, it wasn’t until June 2020 that Janssen updated the U.S. warning label to alert the medical community that pigmentary maculopathy had been identified in Elmiron patients.

In October 2020, the Texas patient was diagnosed by a retinal specialist with chorioretinal degeneration and noted significant pigment changes to the retinal tissue and diffuse outer retina atrophy, elements of Elmiron toxicity.

The patient and her husband are seeking damages for the serious injuries the wife allegedly suffered due to use of Elmiron. The claim was filed in the U.S. District Court for the Eastern District of Pennsylvania.

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Dangerous Medications

Elmiron Linked to Vision Damage

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New studies indicate that the drug Elmiron, a medication already linked to health issues, may also cause vision problems in women with long-term use. The medication is often prescribed as treatment for urinary tract infections as well as osteoarthritis and other conditions.

Studies on Eye Damage

Several studies have been done on the side effects of Elmiron with more investigations underway. Information links Elmiron and vision damage. The amount of damage correlates with the quantity of the medication taken.

Elmiron was approved by the US Food and Drug Administration (FDA) to treat interstitial cystitis, which is a chronic condition of the bladder. It can cause pressure in the bladder along with pain. With long-term use, research indicates that it may be possible for Elmiron to cause pigmentary maculopathy.

This condition impacts the part of the retina known as the macula, which is the central part of the eye. It can cause issues with changes to light. The job of the macula is to protect the retina from UV light, which allows the person to see details better.

The Emory Eye Center, based in Atlanta, GA, made a report that showed that patients who had been taking the drug for about 15 years had changes in their macula. Another 10 patients had a diagnosis of interstitial cystitis and had been prescribed Elmiron. They also showed symptoms that corresponded with pigmentary maculopathy.

Another study was done by Kaiser Permanente which showed that about 24 percent of patients who had been prescribed Elmiron for a minimum of five years had damage to the eye.

Signs of Damage to the Eye

Symptoms associated with this condition include the following:

  • Vision loss
  • Difficulty with reading
  • Vision that is distorted

While the condition can be preventable, it may not be treatable if it develops. This condition is just the latest to be related to Elmiron. Other conditions include the following:

  • Amblyopia
  • Optic neuritis and
  • Retinal hemorrhage

Even after the patient discontinues the mediation, damage may occur. They may have difficulty adapting to an environment with low lighting. The condition can mimic macular degeneration in its later stages.

Anyone experiencing these symptoms after taking Elmiron should talk to their doctor about treatment. While it is never advised to stop taking prescription medication without consulting with their doctor first, it is important to arrange an appointment to discuss their symptoms with a medical professional right away. If they have taken Elmiron in the past and are experiencing vision changes, they will want to present that information to their doctor.

As the only FDA-approved treatment for IC, it must be continually taken, which means that thousands of patients may have been using Elmiron for years or even decades without knowing about the potential for vision damage. Even with the studies being conducted, Janssen Pharmaceuticals failed to warn the public until regulatory agencies applied pressure. Even when warnings were required in Europe and Canada, no changes were made to the labels in the US until June 2020. It is expected that more people will come forward with evidence of vision damage as the public becomes aware of the situation.

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Changes in Priority List for COVID-19 Vaccine

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Supplies for the COVID-19 have been limited in California. At this time, only health care workers, staff and residents in long-term care facilities have been getting it as well as people who are age 65 and older. However, the list for who may be top priority in the future could be changing in the state.

Governor Gavin Newsom has announced who will be top priority for the next phase of vaccination. The plan is to switch to an approach based on age. This is a change from the earlier tier plan where workers who were in commercial and residential settings as well as those who were in transportation and manufacturing would be the next priority. It also included homeless people and those who are incarcerated.

No details about how the groups would be divided by age have been given. Some speculate that it may start with those age 50 and up. Many groups have pushed to have these changes made. However, there are other groups who don’t support the age-based approach. Labor unions are critical because they say essential workers should be protected by getting access to the vaccine right away since they are put at risk for doing their jobs.

Groups that support people with disabilities say that those who are at highest risk aren’t being prioritized. The changes don’t consider those who have the most risk for complications with the virus.

When Vaccinations Will Occur

California state officials have indicated that it may be June before everyone who is 65 and older have been able to get the vaccine. The state is getting about 300,000 to 500,000 doses per week. For Los Angeles County, that many doses would be needed each week just to get the adult residents vaccinated by the middle of summer. It is expected that it will be mid-2022 before everyone is vaccinated.

When it comes to priority by industry, healthcare workers are the top priority. Teachers come next because they are the key to getting schools open again for in-person learning. After teachers, it is workers based in the food and agriculture industries with those in emergency services coming next. There is no current timeline for when those workers are able to sign up for vaccinations.

Vaccinations are going slow in part because a significant portion are going to people getting their second dose. That takes away from those who are seeking their first dose. Adding to the complications is the weather. In Orange County, strong winds caused the Disneyland vaccine site to close, which made thousands of people have to reschedule.

Right now, residents age 65 and older are able to sign up for appointments for vaccination in the state. The goal for Orange County is to get all residents their vaccinations by July 4th. Ventura County is allowing residents age 75 and older to sign up for the vaccine. Other counties have their own restrictions for the vaccine and vaccination sites set up for administration based on the number of doses they receive.

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