Caution is imperative when high doses of intravenous immune globulin (IVIg) treatment are given to obese patients and to patients with risk factors for thrombosis, say researchers who reported on two cases of thrombotic complications.

One patient, with idiopathic thrombo-cytopenic purpura, received 1 g/kg of IVIg per day as a five-hour infusion daily for two days. During the second infusion, she experienced expressive aphasia, right facial droop, and right hemiparesis. The infusion was stopped, and she was given platelets for a presumed intra-cranial hemorrhage. Magnetic resonance imaging showed acute nonhemorrhagic infarcts in the brain, but a transthoracic echocardiogram and carotid ultrasonog-raphy showed nothing significant. On day six, the patient felt pain in her left lower leg, which ultrasound examination revealed to be thrombosis. Enoxaparin sodium (Lovenox® Injection, Aventis) therapy was initiated, and her speech and the hemiparesis improved over the next few days.

Read the rest of this entry »

Although cyclooxygenase 2 (COX-2) inhibitors, also called “coxibs,” can be easier on the gastrointestinal system than nonsteroidal anti-inflammatory drugs (NSAIDs are, some physicians prefer to err on the side of caution by prescribing a gastroprotective agent (GPA) as well. The coxibs were named after two recently developed anti-inflammatory drugs, canadian celecoxib (Celebrex drug, Pharmacia) and rofecoxib (Vioxx®, Merck).

Canadian researchers analyzed data from 42,267 patients who were taking COX-2 inhibitors; 8,235 patients who were taking NSAIDs, and 19,716 patients who received acetaminophen. The researchers concluded that adding a GPA to a coxib constitutes an unnecessary financial burden, particularly if the GPA prescription is unwarranted.

Physicians in the study were more likely to prescribe coxibs than NSAIDs for patients who were older or sicker or who had risk factors associated with gastropathy from NSAID use. They also tended to prescribe coxibs over acetaminophen for patients with musculo-skeletal disorders and osteoarthritis, presumably because of the anti-inflammatory analgesia associated with coxibs. (At the time of the study, rofecoxib had not yet been indicated for rheumatoid arthritis.)

As coxibs gained popularity, it was expected that prescriptions for GPAs might decline along with the decrease in NSAID prescriptions, but that was not the case. GPAs in this study, however, were prescribed 47% less often for coxib users than for NSAIDs users. Studies have indicated that coxibs—although more expensive than NSAIDs—would be cost-effective in patients at high risk for gastrointestinal events with NSAIDs, the investigators noted.

Other studies have shown that the cost-effectiveness of rofecoxib, compared with that of the nonselective NSAIDs, for patients with osteoarthritis is “sensitive to the rate of prophylactic GPA use,” according to the authors.

When the researchers re-analyzed the data, keeping only the patients who did not have any previous gastrointestinal events, cancer, or any filled prescriptions for coxibs, NSAIDs, or acetaminophen, a GPA co-prescription was 61% less frequent with coxibs than with NSAIDs. A co-prescription of a GPA with coxibs was equivalent to one with acetaminophen— a striking finding, the researchers say, considering that physicians do not perceive acetaminophen as being toxic to the gastrointestinal tract.

A new vaccine, which is expected to be able to eliminate six of the 20 injections that babies receive before age two years, has received federal approval. Pediarix™ (GlaxoSmithKline) combines protection, into one injection, against five serious diseases—diphtheria, tetanus, whooping cough (pertussis), hepatitis B, and polio.

The vaccine is to be given in a three-dose series to infants at two, four, and six months of age.
canadian pharmacy generic viagra

Until now, children needed nine shots to protect them; with the new vaccine, they need only three. This approval represents a major breakthrough and should greatly reduce anxiety for both children and their parents.

Montelukast sodium (Singulair canadian, Merck), currently on the market for asthma control, has now been approved for the relief of symptoms of hay fever, also known as seasonal allergic rhinitis. The once-a-day tablet can help to relieve a broad array of allergy symptoms for 24 hours and can be used to treat adults and children as young as two years of age.

Most oral allergy medications work by blocking histamine, one cause of allergy symptoms. Montelukast sodium blocks leukotrienes instead of histamine and specifically targets this underlying cause of allergy symptoms. Leukotrienes, which are produced by certain cells in the body, trigger several effects that have been linked to symptoms of asthma and allergic rhinitis. In some studies, they have been associated with both early-stage allergy symptoms (such as runny nose, nasal itching, and sneezing) and late-stage symptoms (such as congestion).

The drug is available in tablet form for adults (10 mg) and as cherry-flavored, chewable tablets for children (5 mg for those aged six to 14 years old and 4 mg for those aged two to five years old).

Older patients who are treated with topical beta blockers for glaucoma, a major cause of blindness, may be at a higher risk of airways obstruction—even if they have no history of respiratory disease, say researchers from the Institute of Ophthalmology, Royal Brompton Hospital, and Moorfields Eye Hospital, all in London. Analyzing data from 11,739 patients, they found enough of a heightened risk to recommend that frail elderly patients not be given beta-blocker therapy for glaucoma.

Although topical beta blockers are the most widely prescribed drugs for glaucoma in the United Kingdom, they have been known to exacerbate broncho-spasm in patients with asthma and chronic obstructive pulmonary disease and they affect respiratory function in elderly patients with no previous history of airways obstruction. In this study, the attributed risk of new development of respiratory disease was 1,000 patients per year in the United Kingdom, or one case every 11 years for a general practitioner.
online canadian pharmacy

Patients with pre-existing airways obstruction might be even more sensitive to beta blockers, the researchers suggest. If airways obstruction develops, they advise discontinuing the drug immediately and notifying the patient’s ophthalmologist. A refilled prescription that includes topical beta blockers and drugs for asthma should automatically signal an alarm, they warn. The study authors even suggested that many frail elderly patients for whom loss of eyesight was not an immediate threat might fare better with no treatment rather than face a risk of airways obstruction.

Sanofi-Synthelabo and Bristol-Myers Squibb have announced the launch of the REACH (deduction of Atherothrom-bosis for Continued Health) Award Program, which aims to recognize promising work in improving the management of this disease. canadian cialis online

Pegylated interferon (peg-interferon) alfa-2a (Pegasys®, Roche), combined with ribavirin (Rebetol tablet, Schering), is now available for the treatment of patients with chronic hepatitis C virus (HCV). This combination is intended for adults with compensated liver disease and who have not previously taken alpha interferons. (Please see the December 2002 issue of P&T for a review of peg-interferon.)

More patients who received peg-interferon alfa-2a plus ribavirin showed a sustained response to the virus, with the absence of detectable HCV ribonucleic acid (RNA) six months after discontinuation of therapy, compared with patients who received inter-feron-alfa-2b plus generic ribavirin or peg-inter-feron alfa-2a alone.

A once-weekly dose was well tolerated and resulted in improvements in the rate of sustained virologic response.