Introduction Post-market monitoring has revealed an association between the use of leukotriene-modifying agents (LTRAs) and an increased occurrence of neuropsychiatric events. However, the results of observational studies have been inconclusive. Objective To assess the potential correlation between LTRAs exposure and depression in US outpatient adults. Method This population-based cross-sectional study used data from U.S. adults aged 20 to 59 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2016 cycle. The Patient Health Questionnaire-9 was used to assess depression. Multivariable regression was used to evaluate the association between LTRAs exposure and depression. Results Among the 9,539 participants (mean age 40.4 years; 56.2% male), 602 (6.3%) were classified as having depression. LTRAs exposure was associated with a higher prevalence of depression (16.7% [50] vs. 6.0% [552]). In the multivariable logistic regression model LTRAs exposure was associated with depression (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.22~2.83). An association between LTRAs exposure and depression was found in sensitivity analyses that conducted multivariable linear regression with the PHQ-9 score as a continuous variable (β, 0.86; 95% CI, 0.39~1.33), regardless of the PHQ-9 cut-off of 5 or 10, and the multivariable logistic regression results showed that LTRAs use increased the risk of depression (OR = 1.51 [95% CI, 1.12~2.05]; OR = 1.85 [95% CI, 1.22~2.83]). Conclusion Long-term LTRAs exposure is positively associated with depression in the adult outpatient population in the US. Therefore, the risk for depression in patients receiving long-term LTRAs treatment should be considered.

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Background：The irrational use of medicines has become a major problem worldwide. The World Health Organization (WHO) estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately, and advised the pursuit of the responsible use of medicines.In China regulations require that a pharmacist must audit the prescription.Alprostadil injection is a vasodilator and an inhibitor of platelet aggregation There is no obvious or clear indication for its use in the ear, nose and throat (ENT) Department. It came to our notice that in our hospital, alprostadil injection has been prescribed in the ENT Outpatient Department to treat some diseases. Aim: This utilization review on the use of alprostadil injection was carried out in the ear, nose and throat (ENT) Outpatient Department of our hospital to determine its utilization patterns and promote its rational use. Methods: A prescription survey was conducted, and detailed demographic information, including the patient’s age, gender, diagnosis and so on, were recorded in an Excel spreadsheet. The rationality for these prescriptions were retrospectively evaluated.Results: Based on the evaluation results, all alprostadil injections were found to be used off label in the Otolaryngology Department. Furthermore, 98.3% of the prescriptions were for the treatment of sudden hearing loss, 1.1% of the prescriptions for the diagnosis of hypoacusis were considered empirical and should have been more specific, and 0.6% of the prescriptions were for the treatment of Ménière’s disease and large vestibular aqueduct syndrome. There were various dosage regimens for alprostadil injection in clinical practice. However, there was no statistically significant difference in dosage between the different age groups. Moreover, most of the alprostadil injections were given by IV bolus, while 12.2% of patients received this by intravenous drip.Conclusion: The present review indicated that improvements should be made in the quality of prescriptions for alprostadil injection in the Otolaryngology Outpatient Department. Furthermore, there is no strong evidence to support the use of high doses. Future audits of such use may be combined with an awareness campaign to reduce and discourage the irrational use of off label medications.