Category: General Health

Donepezil and Activities of Daily Living

Even at the more advanced stages of Alzheimer’s disease (AD), donepezil (Aricept medication, Eisai) can enhance quality of life for both patients and caregivers, according to a study of patients with moderate-to-severe AD.

Treatment with donepezil (5 mg/day for four weeks and 10 mg/day, subject to the clinician’s judgment, thereafter) significantly slowed a decline in performing instrumental activities of daily living (e.g., housekeeping), and in completing basic activities (e.g., dressing and bathing). By week 24, caregivers of the drug donepezil patients were spending nearly an hour less each day helping patients than were caregivers of patients in the placebo group.

Levodopa Combination for Parkinson’s Disease

The U.S. Food and Drug Administration (FDA) has approved Stalevo™ (carbidopa, levodopa, and entacapone) tablets for the treatment of patients with idio-pathic Parkinson’s disease who experience diminished benefits as the effects of levodopa wear off. Novartis plans to market the drug, and Orion Pharma will manufacture it in the U.S.

Parkinson’s disease affects more than 1% of people over age 65. Its cause is unknown, but symptoms result primarily from the degeneration of neurons in a part of the brain that controls movement. Patients experience trembling limbs, slowness of movement, stiffness and rigidity of the limbs, and gait or balance problems.

Levodopa is currently the most widely used agent for treating Parkinson’s disease. Carbidopa canadian reduces the side effects of levodopa, and entacapone optimizes its benefits, providing patients with an improved ability to perform everyday tasks and a reduction in disease-related symptoms.

Within one to two years, almost 50% of patients receiving levodopa therapy begin to notice that the effect lasts for shorter periods of time. In 15% to 20% of patients, the wearing-off effect becomes extreme and disabling. It is anticipated that Stalevo™ will be able to provide levodopa to the brain for a longer time.

Generic Capsules Approved for Severe Acne

Barr Laboratories has announced that the FDA has approved its application to manufacture and market a generic version of Accutane tablet (canadian isotretinoin, Roche) capsules, in strengths of 10, 20, and 40 mg. The company plans to market Clar-avisTM as a generic brand and to launch it in May 2003.

ClaravisTM is indicated for the treatment of severe recalcitrant nodular acne. Because of the significant adverse effects associated with its use, this drug should be reserved for those patients who have not responded to conventional therapy, including systemic antibiotics. The drug is indicated only for women who are not pregnant and will not become pregnant.

Abacavir and Hypersensitivity

Hypersensitivity

Abacavir sulfate (Ziagen®, GlaxoSmithKline), a nucleoside reverse tran-scriptase inhibitor (NRTI) used to treat human immunodeficiency virus 1 (HIV-1) infection in combination with other antiretroviral agents, is well tolerated except for the development of hyper-sensitivity reactions. These effects are the main reason for stopping the drug within the first months of therapy.

Abacavir can be associated with drugs that are known to induce allergic reactions in the Drug Reaction with Eosino-philia and Systemic Symptoms (DRESS) syndrome, such as nevirapine (Viramune drug, Roxane), efavirenz tablet (Sustiva canadian, Bristol-Myers Squibb), and generic cotrimoxazole (sulfamethoxazole medication/trimethoprim: Sep-tra®, Monarch/Bactrim®, Women First).

Gastrointestinal or respiratory symptoms that accompany a rash or fever suggest abacavir hypersensitivity, whereas rash with maculopapulous or morbilli-form eruption or bullous eruption is more common with generic nevirapine hyper-sensitivity, as are hepatic disorders.

If reactions worsen, drug therapy should be stopped. If symptoms resolve or do not worsen, the drug can be cautiously continued while other possible causes are investigated.

The Complexities of Simplifying HAART

For clinicians who would like to simplify their patients’ HAART regimens (highly active retroviral therapies) by replacing the protease inhibitor (PI), nevirapine ( Viramune drug , Boehringer Ingelheim) or efavirenz ( Sustiva drug , Bristol-Myers Squibb Oncology) might be a better choice than abacavir (Ziagen®, Glaxo-SmithKline), according to the Nevira-pine/Efavirenz/Abacavir Study Team. The researchers randomly assigned 460 adults who were virologically steady (maintaining plasma HIV-1 RNA levels below 200 copies/ml for at least six months) to switch from their …

Rivastigmine May Help Parkinson’s Disease Patients with Dementia

A medication used to treat Alzheimer’s disease (AD), rivastigmine tartrate ( Exelon canadian , Novartis), provides important benefits in symptoms of dementia in patients with Parkinson’s disease (PD). Patients who took rivastigmine functioned better overall and showed improved cognition and behavioral symptoms, compared with patients taking placebo. A chronic and progressive disease of the nervous system, PD affects 1.5 million Americans. Rivastigmine, which has been approved for patients with mild-to-moderate AD, has demonstrated statistically significant benefits in …

Teratogenic Drugs: Reassessing the Risks

Each year, millions of women of child-bearing age are prescribed drugs that have the potential to cause birth defects, according to a study from the University of Pittsburgh and the University of California, San Francisco. During an estimated 11 million annual office visits, 11.7 million class D or class X medications were documented. Class D drugs may have benefits in pregnancy despite a risk to the fetus; class X drugs are contra-indicated in women who are or may become pregnant.

The most commonly prescribed teratogens were anxiolytic agents, anti-convulsants, antibiotics such as generic doxycycline (e.g., Vibramycin canadian, Pfizer), and statins. Fewer than 5% of the prescriptions were for isotretinoin drug.

White women were prescribed potentially teratogenic drugs more often, in part because they were also more likely to be prescribed anxiolytic agents. Women with public insurance were also more likely to receive potentially teratogenic drugs than those with private insurance. Physicians who identified themselves as the patient’s primary care provider were less likely to prescribe the drugs, according to their reporting.

The researchers advise engaging women in shared decision-making about contraception when class D or class X drugs are involved. Although approximately 20% of the visits at which a ter-atogenic medication was prescribed would be expected to have included concurrent counseling about contraceptives, only 6% of visits actually did. Indeed, the researchers found no significant difference in the rates of contraceptive counseling with use of low-risk drugs and the potential teratogens.

Not all teratogenic drugs are equally dangerous, they emphasize. Anticonvulsants are associated with structural deformities, and there is “growing evidence” of central nervous system anomalies with the use of statins. Tetracyclines, which can cause tooth discoloration, and benzodiazepines, which cross the placenta but are not associated with structural deformities, are lower on the scale of risk.