June 17th 2021
The COX-2 inhibitor Anjeso, a faster-acting injectable formulation of meloxicam, reduces opioid use after surgery.
November 18th 2014
June 13th 2013
June 12th 2013
Perspectives on empiric and chronic proton pump inhibitor therapy
August 1st 2004The number of patients presenting with typical gastroesophageal reflux disease (GERD) symptoms and the prevalence of GERD symptoms in the general population make the prescription of proton-pump inhibitors (PPIs) by primary-care physicians commonplace. An active medication use evaluation (MUE) program that places symptom control as a primary concern can help rationalize PPI drug therapy and improve patient care. A treatment guideline that follows the current practice of empiric therapy, recommends periodic monitoring, and encourages further gastroesophageal evaluation (ie, endoscopy and pH monitoring) for assessing adequacy of treatment and treatment failures is a key component of a successful program.
Statin therapy should be considered for all patients with type 2 diabetes
July 1st 2004A recent study found that atorvastatin at its starting dosage reduces the risk of a first major cardiovascular event in patients with type 2 diabetes, said Helen Colhoun, MD, at the 64th scientific sessions of the American Diabetes Association (ADA) in Orlando.
Normal liver enzymes no reason to withhold antiviral therapy for chronic HCV
July 1st 2004At Digestive Disease Week in New Orleans, Steve Flamm, MD, associate professor of medicine and medical director of liver transplantation, Northwestern University, Chicago, Ill, presented study findings indicating that patients with chronic hepatitis C virus (HCV) infection and persistently normal liver enzymes derive as much benefit from pegylated interferon-alfa 2b plus ribavirin therapy as do patients with elevations in serum alanine aminotransferase (ALT). According to Dr Flamm, lead investigator for the study, "... a fraction of patients with normal liver enzymes do have aggressive liver disease on liver biopsy despite their liver tests being normal."
Novel antibiotic may prevent travelers' diarrhea
July 1st 2004Rifaximin (Xifaxan, Salix), the first nonsystemic, gastrointestinal-selective oral antibiotic to receive approval for the treatment of travelers' diarrhea, is also an effective prophylaxis for travelers' diarrhea, according to data released at Digestive Disease Week in New Orleans.
Rofecoxib use increases congestive heart failure risk compared to celecoxib and nonselective NSAIDs
July 1st 2004A study was conducted to assess hospital admission rates for congestive heart failure in patients dispensed cyclooxygenase-2 (COX-2) inhibitors or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). Researchers at the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada, studied patients taking rofecoxib (Vioxx, Merck), celecoxib (Celebrex, Pfizer), and nonselective NSAIDs, with a control group consisting of non-NSAID users who were not given any study drugs. Study findings indicate that, relative to non-NSAID users, patients receiving rofecoxib and nonselective NSAIDs had an increased risk of admission for congestive heart failure than patients taking celecoxib.
TNF inhibitor use associated with granulomatous infectious disease; infliximab poses greatest risk
July 1st 2004Tumor necrosis factor (TNF) antagonists increase the risk of granulomatous infectious disease, including tuberculosis, according to a study-the largest of its kind to date-published in the journal Clinical Infectious Diseases. The risk of infection was 3.25-fold greater among patients who received infliximab (Remicade, Centocor) than among those who received etanercept (Enbrel, Wyeth/Amgen), the study found.
New molecular entity: Trospium
July 1st 2004The parasympatholytic action of trospium reduces the tonus of smooth muscle in the bladder by antagonizing the effect of acetylcholine on muscarinic receptors. Trospium was approved on May 28, 2004, for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.
New molecular entity: Rifaximin
July 1st 2004This nonsystemic, gastrointestinal-selective oral antibiotic exerts its effect by binding to the beta-subunit of bacterial DNA- dependent RNA polymerase. Rifaximin was approved on May 25, 2004, for the treatment of travelers’ diarrhea caused by noninvasive strains of Escherichia coli in patients aged 12 years and older.
Calcium and phosphorus management in chronic kidney disease: Challenges and trends
July 1st 2004Common and serious comorbidities in chronic kidney disease include bone and mineral disorders, especially hyperphosphatemia and secondary hyperparathyroidism, and cardiovascular calcification and cardiovascular disease. Managing these complications typically requires the use of phosphate-binding compounds and vitamin D analogues. The selection and use of phosphate-binding agents in particular requires careful consideration of various factors such as calcium load and increased risk of subsequent cardiovascular calcification. Currently available calcium-containing phosphate binders have been demonstrated to contribute to patient calcium loads, and their use in hemodialysis patients has been associated with significant and progressive cardiovascular calcification. Thus, there is increasing interest in the use of calcium-free products, which can effectively bind phosphate without enhancing the risk for cardiovascular calcification.
IV esomeprazole: A new proton pump inhibitor formulation
July 1st 2004The intravenous (IV) formulation of esomeprazole, the S-isomer of the proton pump inhibitor (PPI) omeprazole, is currently under FDA review for the short-term treatment of gastroesophageal reflux disease (GERD) as an alternative in patients unable to continue taking oral esomeprazole. Clinical studies have shown esomeprazole to be equivalent to the other currently available PPIs with respect to safety. The intravenous formulation, given either as a 30-minute infusion or 3-minute injection, has been found to be comparable to the oral dosage form based on pharmacokinetic and pharmacodynamic studies in healthy subjects. Limited studies suggest that IV esomeprazole 40 mg/d may provide a more effective antisecretory profile than either IV lansoprazole 30 mg/d or IV pantoprazole 40 mg/d. Data on clinical efficacy is limited to 1 abstract that reported no significant differences in healing rates in subjects with erosive esophagitis administered esomeprazole either 40 mg orally or IV daily. More clinical studies are needed to define its limited role as an alternative in those patients with acid-related disorders unable to tolerate the oral formulations.
States jump on drug import bandwagon
June 1st 2004More state governments and public health agencies that are facing funding cutbacks are looking for ways to obtain less expensive pharmaceuticals from Canada in order to reduce spending on pharmaceuticals. So far this year, 21 states have considered drug reimportation bills or resolutions, according to the National Conference of State Legislatures.
Acetaminophen linked to increased rate of newly diagnosed adult-onset asthma
June 1st 2004Acetaminophen use is associated with an increased rate of newly diagnosed adult-onset asthma, according to a study published in the American Journal of Respiratory and Critical Care Medicine. The study findings, from the Nurses Health Study, confirmed and extended the results of similar cross-sectional studies, although the authors stated that it would be premature to recommend the avoidance of acetaminophen for all adults with asthma.
Early-stage breast cancer patients not receiving full benefits of chemotherapy
June 1st 2004More than half the women suffering from early-stage breast cancer (ESBC) are at increased risk of recurrence or death because of substantial reductions-planned or unplanned-in relative dose-intensity (RDI) when treated with adjuvant chemotherapy, according to a study published in the Journal of Clinical Oncology.
Clopidogrel combined with aspirin lowers risk of CEA-induced cerebral emboli
June 1st 2004Combination use of clopidogrel and aspirin the night before undergoing carotid endarterectomy (CEA) may significantly reduce the risk of cerebral emboli, according to a study published in the journal Circulation.
ACE inhibitor delays prevalence of WML in stroke victims
June 1st 2004Perindopril, an angiotensin-converting enzyme (ACE) inhibitor, can help stop or delay the progress of white matter lesions (WML) in patients with prior cerebrovascular disease, according to research presented at the annual meeting of the American Academy of Neurology.
Adjusted-dose warfarin lowers stroke risk in AF patients vs aspirin
June 1st 2004Adjusted-dose warfarin compared to aspirin more effectively reduces the high risk of secondary stroke in atrial fibrillation (AF) patients who have a history of transient ischemic attack (TIA), according to a study published in the journal Stroke.
Switching from tamoxifen to exemestane could reduce breast cancer recurrence
June 1st 2004Disease-free survival in postmenopausal women with primary breast cancer significantly improved when tamoxifen monotherapy treatment was switched to exemestane therapy after 2-3 years, according to a study published in the New England Journal of Medicine. The existing treatment paradigm calls for tamoxifen, an estrogen-receptor modulator, to be taken alone for all 5 years, but some patients have experienced relapse.
The appropriateness of hospital antimicrobial use between medical and surgical specialties
June 1st 2004Two published studies from the 1970s describe a higher inappropriate use of antimicrobials among surgeons compared to internal medicine physicians. If this assertation is indeed true, institutions with limited resources should focus interventions on surgical services to improve antimicrobial use. The appropriateness of antimicrobial use in internal medicine and general surgical patients over a 10-month period was evaluated at the University of Louisville Hospital (Louisville, Ky) based upon established institutional antimicrobial guidelines. Antimicrobial selection and dose were evaluated for 1,300 antimicrobial courses. Compliance to institutional guidelines for antimicrobial selection and dose were found in 448 (93%) of 480 courses prescribed by internal medicine services and 728 (88%) of 820 courses prescribed by surgical services (P=.009). Although we were able to identify a 5% difference among specialties, we did not consider this to be a clinically significant difference. We concluded that focused interventions to improve antimicrobial use at the University of Louisville should be applied equally to medical and surgical specialties.
Darifenacin: An M3-selective muscarinic antagonist for the treatment of overactive bladder
June 1st 2004Darifenacin (Enablex, Novartis) is a muscarinic antagonist in phase 3 clinical trials for the treatment of overactive bladder (OAB). Darifenacin demonstrates relative selectivity for the M3 muscarinic receptor subtype over the M1 and M2 subtypes. In clinical trials, darifenacin has been compared to placebo for the treatment of symptoms of OAB in adult men and women. Patients treated with darifenacin experienced significantly greater reductions in the number of incontinence episodes per week, nocturnal awakenings, and warning time before micturitions. It appears to have similar efficacy to available anticholinergic agents for the treatment of OAB. Commonly reported adverse events include dry mouth and constipation, and preliminary data suggest that darifenacin may be associated with decreased impairment of salivary flow versus oxybutynin. Darifenacin has not been found to have an effect on the cardiovascular system or cognition in clinical trials. Further research is needed to determine the efficacy of darifenacin compared to other available anticholinergic agents such as oxybutynin and tolterodine, as well as emerging therapies. In addition, further investigation of the adverse effect profile in elderly patients is warranted.