People who have recently had a heart attack are encouraged to reduce their low-density lipoprotein (“bad”) cholesterol (LDL-C) to even lower levels than previously recommended, according to new guidelines.
A target goal of 70 mg/dl is urged for patients who have just had a heart attack or those who already have cardiovascular disease plus diabetes; who are persistent smokers; or who have high blood pressure or other multiple risk factors.
For fast migraine relief without gastrointestinal symptoms, rofecoxib (Vioxx®, Merck), a long-acting selective cyclo-oxygenase-2 inhibitor, might be an answer. Researchers who conducted a parallel-group, multicenter study found the drug to be effective in just 30 minutes.
The researchers compared two doses of rofecoxib (25 and 50 mg) with placebo in 538 patients. Both doses were statistically superior to placebo in the acute treatment of a migraine attack as well as in relieving pain, photophobia, phono-phobia, nausea, and functional disability and in reducing the use of rescue medications. canadian discount pharmacy
The drug was well tolerated, and most clinical adverse events were mild to moderate in both treatment groups.
The South African government has rejected a common treatment used to reduce the transmission of the AIDS virus by pregnant women to their babies. Instead, it has recommended a 28-week regimen that combines nevirapine (Viramune generic) and generic zidovudine (Medication Retrovir® AZT, GlaxoSmithKline), a more complex schedule that might reach fewer women.
The Medicines Control Council recommended against giving pregnant, HIV-positive women a single dose of the drug nevirapine just before childbirth, even though the practice has become common in Africa. The Council ruled that mothers who took the drug would be likely to develop drug resistance to anti-retroviral therapy and that nevirapine was more effective when used in combination with other drugs.
Health experts have condemned the decision as another example of South Africa’s reluctance to confront the AIDS epidemic head-on, even though more than 5 million of its citizens are infected with HIV.
Although the regimen recommended by the regulators is theoretically better, the risk of creating a generation of infected children is thought to outweigh the risk of creating drug resistance.
The country’s register of medicines claims that treating pregnant women with single doses of nevirapine during childbirth increases the likelihood that antiretroviral therapy would not work for them when they become sick later in life.
The World Health Organization supports the treatment of pregnant women with nevirapine alone. In many African nations, pregnant women wait too long to begin a 28-week course of therapy. Usually, a shorter course of antiretrovirals or a single dose of nevirapine for the mother and baby are the only options. Although a single dose of nevirapine increases drug resistance, it reduces the risk of transmission from 30% to nearly 15%.
The Food and Drug Administration (FDA) has approved the antibiotic rifaximin (Xifaxan™, Salix) 200 mg to treat travelers’ diarrhea in patients 12 years of age and older. In clinical trials, the drug helped to shorten the duration of diarrhea for the most common cause of this disease, namely, noninvasive strains of Escherichia coli.
Rifaximin should not be used for diarrhea that is complicated by fever or blood in the stool or for diarrhea caused by pathogens other than E. coli. It should be discontinued if diarrhea symptoms worsen or last more than 24 to 48 hours. canadian cialis
The product is expected to be available in August 2004.
The FDA has approved paricalcitol injection (Zemplar®, Abbott Labs) for children and adolescents with secondary hyperparathyroidism who are undergoing hemodialysis. Zemplar® was initially introduced in 1998.
Because patients with kidney failure do not produce the active form of vitamin D, they have vitamin D deficiency and secondary hypoparathyroidism, in which the parathyroid glands produce excess amounts of parathyroid hormone (PTH).
Approximately 1,400 American children between ages 5 and 19 undergo hemodialysis.
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Secondary hyperparathyroidism can lead to weak and brittle bones, anemia, and cardiac and neurological problems. Because bones and other organs are still developing in children, and because children are typically patients for longer periods of time, the disease can be more difficult to treat than in adults. Left untreated, secondary hyperparathyroidism can be a factor in growth retardation.
Zemplar® was tested in a 12-week randomized, double-blind, placebo-controlled study of 29 pediatric hemo-dialysis patients with chronic renal failure. Nearly all patients had received a form of vitamin D therapy before the study. Sixty percent of the Zemplar® patients showed two consecutive 30% decreases in PTH levels; only 21% of the placebo patients did. Fewer Zemplar® patients (23%) than placebo patients (31%) experienced elevated serum calcium levels.
The overall percentage of serum calcium measurements (defined as 10.3 mg/dl or greater) was 7% in the Zemplar® group and 7% in the placebo group. Hypercalcemia did not occur in either group during the study.
When interferon-based treatment does not appear to be working in patients with hepatitis C virus (HCV) infection, a new once-daily, antiviral oral treatment might be the answer. NM283 (Idenix Pharmaceuticals), which passed its first human clinical trial with flying colors, metabolizes to a form that inhibits HCV RNA polymerase.
In a multicenter trial, 82 patients completed treatment; 68 patients received NM283 and 14 received placebo. All of the patients had chronic HCV infection (genotype 1 strain) and either had not received previous treatment or had not responded to interferon-based therapy.
Aspirin, often used to help prevent heart attacks and strokes, also appears to reduce the risk of the most common type of breast cancer— that is, tumors whose growth was fueled by estrogen or progesterone. Approximately 70% of women with breast cancer have the hormone receptor-positive type.
The women who used aspirin at least four times a week for at least three months were almost 30% less likely to develop hormone-related breast cancer than women who used no aspirin. Aspirin had no effect on the risk for hormone receptor-negative tumors.
Researchers believe that aspirin works by interfering with the body’s production of estrogen.
Many studies have relied on subjects’ recollections of how often they took aspirin. A more rigorous study has linked the use of low-dose aspirin and a reduced risk of growths that can eventually turn into colon cancer. That study involved randomly assigning patients to take aspirin or placebos, the gold-standard method.
For now, it is not recommended that all women take aspirin, because it can cause side effects such as stomach bleeding. Although the findings are exciting, more research is needed before doctors recommend aspirin to prevent breast cancer.
