buprenorphine

Sublingual Tropicamide Eye Drops for the Management of Clozapine-Induced Hypersalivation: A Case Series of Seven Patients.

Chatterjee Seshadri Sekhar SS, Das Soumitra S, Agrawal Adesh A

Clozapine-induced hypersalivation (CIH) affects 30-80% of patients on clozapine and is a major contributor of non-adherence. Current managements, largely based on systemic anticholinergics, can worsen other clozapine-related side effects. Here sublingual tropicamide 1% eye drops can be a low-cost alternative worth evaluating. We report a case series of seven patients with schizophrenia treated with sublingual tropicamide 1% ophthalmic solution (4-8 drops/day) for CIH. Treatment response was assessed by patient-reported percentage reduction in salivation. All seven patients reported improvement (25-80%). One patient reported a transient bitter taste; no systemic anticholinergic effects occurred. Sublingual tropicamide was associated with patient-reported improvement in CIH and was well tolerated in this small, uncontrolled series. Its short duration of action and local administration may offer practical advantages over systemic anticholinergics, though the mechanism remains unproven. Randomised trials with validated outcome measures are needed to establish its efficacy and safety.

Trends in Fentanyl Dispensing in Spain: The Case of Galicia (2019-2025).

Vázquez-Prieto Severo S, Vaamonde Liste Antonio A

In recent years, numerous countries have recorded a steady increase in opioid use. Although prescribing practices vary considerably among them, fentanyl is among the most frequently prescribed strong opioids in several European countries and in Spain. In this study, we analyzed the evolution of outpatient fentanyl dispensing in Galicia, Spain, between January 2019 and December 2025, using the Anatomical Therapeutic Chemical Classification/Defined Daily Dose (ATC/DDD) system. We paid particular attention to differences between provinces and explored temporal trends broken down by route of administration (buccal, nasal, sublingual and transdermal). Dispensing data were obtained from the General Sub-directorate of Pharmacy of the Galician Health Service (SERGAS) from the monthly billing database of official prescriptions dispensed in Galician pharmacies and were expressed as defined daily dose per 1000 inhabitants per day (DID). Dispensing rates between provinces were compared using the non-parametric Kruskal-Wallis test, considering a p-value less than 0.05 as statistically significant. We observed an increase in fentanyl use between 2019 and 2021, followed by a systematic decrease during the 2022-2025 period. Significant differences (p < 0.001) were found in the defined daily dose per 1000 inhabitants per day (DID) among the four Galician provinces, and demographic and socioeconomic factors partially explain the observed disparities. Regarding pharmaceutical presentations, transdermal patches were the most frequently used form during the study period. While some limitations should be noted, the results suggest that the observed decrease in fentanyl dispensing in Galicia could be associated with the implementation of the Ministry of Health's 2021 optimization plan, with a sustained reduction in its dispensing from 2022 onwards. However, it is necessary to maintain pharmacovigilance at the provincial level.

Corrigendum to 'Sublingual or Oral versus vaginal misoprostol for cervical priming prior to first-trimester surgical abortion: a systematic review and meta-analysis' [American Journal of Obstetrics and Gynecology 234/4 (2026) 980-1002].

Fonseca Queiroz Laura L, Lemos Maria Julia MJ, Diniz Alice França AF, Longo da Silva Celene Maria CM et al.

Methadone treatment and associated health and social outcomes after a national manufacturing closure in Mexico: a longitudinal observational cohort study in Tijuana.

Goldshear Jesse Lloyd JL, Harvey-Vera Alicia A, Rangel Gudelia G, Abramovitz Daniela D et al.

Medications for opioid use disorder (MOUD) are key to the prevention of drug overdose and bloodborne infections among people with OUD while also improving psycho-social wellbeing. From February to August 2023, following government orders, Psicofarma, Mexico's primary methadone production facility remained closed, interrupting its supply nationwide. We aimed to explore associations between the time periods during and after the closure and prevalence of methadone treatment, drug use, mental health and social harms among methadone treatment patients. We examined these associations among 200 MOUD clinic patients in Tijuana, using log-binomial regressions via generalized estimating equations (GEE) over three six-month response periods during and post-closure (Period 1, during and post: 07/2023-01/2024, Period 2, post, limited availability: 02/2024-07/2024 and Period 3, post, restored availability but fewer clinics open: 08/2024-12/2024). We ran three sets of GEE models to test for potential mediation effects of methadone treatment on associations between response period and deleterious outcomes. Time period was associated with methadone treatment (i.e., significant decline from 36% in Period 1-13% and 26% in Periods 2 and 3, respectively), and with drug use (opioids, methamphetamine, benzodiazepines, injection use), and mental health (anxiety symptoms) outcomes. Methadone treatment often suppressed the strength of the associations between time periods during and after the Psicofarma's closure and drug use/mental health outcomes, which was consistent with a partial mediating role, but formal causal mediation could not be established due to data limitations. Although other unmeasured changes may have occurred during the study period, these findings suggest that the methadone shortage may have contributed to prolonged adverse effects on patients and highlight the need for policies that ensure consistent MOUD provision in Mexico, including the authorization of buprenorphine for the treatment of OUD. This study was funded by the National Institute on Drug Abuse (R01DA049644, K01DA062723, T32DA023356, R33DA061260) and the San Diego Center for AIDS Research, an NIH supported program (P30 AI036214).