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NSAID Use (nsaid + use)

Distribution by Scientific Domains

Medical Sciences	95%

Distribution within Medical Sciences

Pharmacology & Pharmaceutical Medicine	42%
Oncology & Radiotherapy	21%

Selected Abstracts

A long-term cohort study of nonsteroidal anti-inflammatory drug use and disease activity in outpatients with inflammatory bowel disease

INFLAMMATORY BOWEL DISEASES, Issue 6 2004
Gregory F. Bonner MD
Abstract Background and Aims: We examined whether use of nonsteroidal anti-inflammatory drugs (NSAIDs) in outpatients with inflammatory bowel disease was associated with increased severity of disease activity. Methods: Outpatients with Crohn's disease (CD; n = 426) and with ulcerative colitis (UC; n = 203) were seen between November 1997 and April 2002. Patients were questioned at each visit regarding use of prescription or over-the counter NSAIDs and a clinical disease activity index (modified Harvey Bradshaw [MHB] or Lichtiger score) was obtained. Results: For the Crohn's patients, for 1315 visits no NSAIDs were used, on 215 visits low-dose NSAIDs were used, and for 139 visits high-dose NSAIDs were taken. For UC patient visits, 495 used no NSAIDs, 112 low-dose NSAIDs, and 49 high-dose NSAIDs. Average MHB score was 4.07 for the no-NSAID group, 4.24 for low-dose NSAIDs (P = 0.46), and 4.78 for high-dose (P = 0.0072 versus no NSAIDs). For the ulcerative colitis patients corresponding scores were 5.64, 5.46, and 6.20, respectively (P = not significant). The probability of moderately active disease as defined by crossing a threshold MHB or Lichtiger score, however, was not significantly affected by NSAID use. Subgroup analysis indicated the increase in disease activity among CD patients taking high-dose NSAIDs was limited to patients with colonic involvement. Conclusions: Use of low-dose NSAIDs was not associated with an increase in disease activity for these outpatients with either CD or UC. Use of high-doses of NSAIDs was associated with a higher numerical disease activity index score among CD patients with colonic involvement, but this was not reflected by an increase in significant disease flares. [source]

Nonsteroidal anti-inflammatory drugs and the risk of developing breast cancer in a population-based prospective cohort study in Washington County, MD

INTERNATIONAL JOURNAL OF CANCER, Issue 1 2007
Lisa Gallicchio
Abstract The objective of this study was to examine the association between nonsteroidal anti-inflammatory drug (NSAID) use and the development of breast cancer, and to assess whether this association differed by estrogen receptor (ER) subtype. Data were analyzed from 15,651 women participating in CLUE II, a cohort study initiated in 1989 in Washington County, MD. Medication data were collected at baseline in 1989 and in 1996. Incident cases of invasive breast cancer occurring from baseline to March 27, 2006 were identified through linkage of cohort participants with the Washington County Cancer Registry and the Maryland State Cancer Registry. Cox proportional hazards modeling was used to calculate the risk ratios (RR) and 95% confidence intervals (95% CI) for breast cancer associated with medication use. Among women in the CLUE II cohort, 418 invasive breast cancer cases were identified during the follow-up period. The results showed that self-reported use of NSAIDs in both 1989 and in 1996 was associated with a 50% reduction in the risk of developing invasive breast cancer compared with no NSAID use in either 1989 or 1996 (RR = 0.50; 95% CI 0.28, 0.91). The protective association between NSAID use and the risk of developing breast cancer was consistent among ER-positive and ER-negative breast cancers, although only the RR for ER-positive breast cancer was statistically significant. Overall, findings from this study indicate that NSAID use is associated with a decrease in breast cancer risk and that the reduction in risk is similar for ER-positive and ER-negative tumors. © 2007 Wiley-Liss, Inc. [source]

Nonsteroidal antiinflammatory drug use and risk of bladder cancer in the health professionals follow-up study

INTERNATIONAL JOURNAL OF CANCER, Issue 10 2007
Jeanine M. Genkinger
Abstract Nonsteroidal antiinflammatory drugs (NSAIDs) use, particularly aspirin, may lower the risk of several cancers, including bladder. NSAIDs may reduce development of bladder tumors by decreasing inflammation, inhibiting cycloxygenase-2, inhibiting proliferation and inducing apoptosis of cancer cells. However, acetaminophen, a major metabolite of phenacetin, may be positively associated with bladder cancer risk. Results from case-control studies on NSAIDs and acetaminophen use and bladder cancer risk are inconsistent. We investigated the association between NSAID and acetaminophen use and bladder cancer risk in a large cohort of US males. Among 49,448 men in the Health Professionals Follow-Up Study, 607 bladder cancer cases were confirmed during 18 years of follow-up. Relative risks (RR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards models. Multivariate RR were adjusted for age, current smoking status, pack years, geographic region and fluid intake. No significant associations were observed for regular aspirin (,2 tablets per week), (RR = 0.99, 95% CI 0.83,1.18), ibuprofen (RR = 1.11, 95% CI 0.81,1.54), acetaminophen (RR = 0.96, 95% CI 0.67,1.39) or total NSAID use (not including acetaminophen; RR = 1.01, 95% CI 0.85,1.20) and bladder cancer risk compared with nonuse. Consistent use (over 6 years) of aspirin, ibuprofen, acetaminophen and total NSAIDs, compared to nonuse, was not associated with bladder cancer risk. No association was observed between aspirin frequency and dose and bladder cancer risk. We observed no effect-modification by smoking, age or fluid intake. Our results suggest that regular NSAID or acetaminophen use has no substantial impact on bladder cancer risk among men. © 2007 Wiley-Liss, Inc. [source]

Effect of NSAIDs on the recurrence of nonmelanoma skin cancer

INTERNATIONAL JOURNAL OF CANCER, Issue 3 2006
Maria V. Grau
Experimental studies have consistently shown a protective effect of nonsteroidal antiinflammatory drugs (NSAIDs) against nonmelanoma skin cancers (NMSC). However, little human epidemiological research has been done in this regard. We used data from the Skin Cancer Chemoprevention Study to explore the association of NSAID use and with the risk of basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC). 1,805 subjects with a recent history of NMSC were randomized to placebo or 50 mg of daily ,-carotene. Participants were asked about their use of over-the-counter and prescription medications at baseline and every 4 months during the trial. Skin follow-up examinations were scheduled annually with a study dermatologist; confirmed lesions were the endpoints in the study. We used a risk set approach to the analysis of grouped times survival data and unconditional logistic regression to compute odds ratios [ORs] for various exposures to NSAIDs. The use of NSAIDs was reported in over 50% of questionnaires. For BCC, NSAIDs exhibited a weak protective effect in crude analyses, which attenuated markedly after adjustment. For SCC, the use of NSAIDs in the year previous to diagnosis reduced the odds by almost 30% (adjusted OR= 0.71, 95% CI 0.48,1.04). When we accounted for frequency of use, results for BCC were not striking, and there were inconsistent suggestions of an inverse association with SCC. There were some indications of a modest, nonsignificant reduction on the number of BCCs and SCCs with NSAID use. Our data suggest a weak and inconsistent chemopreventive effect of NSAIDs on BCC and SCC. © 2006 Wiley-Liss, Inc. [source]

An unusual cause of dizziness in bulimia nervosa: A case report

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2005
Randy A. Sansone MD
Abstract Objective The current article describes the case of a 23<->year<->old female with purging<->type bulimia nervosa who was evaluated by her primary care physician for dizziness and lightheadedness. Methods After laboratory studies were performed by her primary care physician, the patient was admitted to the hospital because of severe anemia. The patient had been taking nonsteroidal antiinflammatory drugs <(>NSAIDS<)> at prescribed doses for shin splints that were secondary to jogging and developed gastric erosion. Results Endoscopic examination showed that she had diffuse gastritis with linear, streaky ulcerations throughout the body of the stomach. Discussion Lightheadedness is a common clinical symptom among individuals with eating disorders, but is typically related to dehydration, malnutrition, hypometabolism, andor combinations of these factors. Clinicians need to consider NSAID use, which may cause erosive gastritis, blood loss, and lightheadedness. © 2005 by Wiley Periodicals, Inc. [source]

Non-prescription medicine use by outpatients of a hospital in north-central Trinidad living with hypertension, and the potential clinical risks

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2008
Miss Rian Extavour Assistant Lecturer, principal investigator
Objective To describe the reported use of non-prescription medicines (NPMs) and the reported frequency of use by outpatients living with hypertension; to identify potential drug-drug and drug-disease interactions between reported NPMs and either antihypertensives prescribed or hypertension. Setting Adult outpatient clinics of the Eric Williams Medical Sciences Complex Adult Hospital in Trinidad. Method Outpatients were interviewed about their use of NPMs using a structured instrument. Chi-squared test or Fisher's exact test was used to test for associations between NPM use and selected variables: age group, gender, education level, number of prescribed medicines, use of prescribed medicines and the presence of comorbidities. Combinations of NPMs and antihypertensive drugs or hypertension itself that may lead to undesirable interactions were identified. Key findings One hundred and fifty-five clients were interviewed (mean age 61 years; 46% men; 56% of East Indian descent). Of these, 82% were living with a cardiac condition and 60% with diabetes mellitus. In addition, 92% reported using NPMs to treat minor illnesses. Analgesic use was reported by 81%. Some 66% reported using paracetamol, 54% reported antitussives, 48% antacids, 47% antihistamines and 39% said they used sympathomimetic drugs. The majority (98%) of NPMs were used only when needed. Sixty per cent had at least one combination a with risk of interaction with NPMs and hypertension or antihypertensive medicines: 16% had risk of interactions between enalapril (or captopril) and antacids, 13% between angiotensin-converting enzyme (ACE) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs), 12% between beta-blockers and NSAIDs and 12% between thiazide diuretics and NSAIDs. Thirty-nine per cent had a drug-disease interaction risk due to sympathomimetic drugs and 26% had one due to NSAID use. Conclusion Based on self-reports, outpatients living with hypertension in north-central Trinidad use NPMs when needed to treat minor illnesses, mainly paracetamol for pain. Non-prescription-antihypertensive interactions may arise due to ACE inhibitor/antacid combinations and NPM-hypertension interactions may result from use of sympathomimetics. Interactions may also arise as a result of the use of NPMs containing NSAIDs and sodium. [source]

Rescue strategies against non-steroidal anti-inflammatory drug-induced gastroduodenal damage

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2009
Yun Jeong Lim
Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs worldwide, which attests to their efficacy as analgesic, antipyretic and anti-inflammatory agents as well as anticancer drugs. However, NSAID use also carries a risk of major gastroduodenal events, including symptomatic ulcers and their serious complications that can lead to fatal outcomes. The development of "coxibs" (selective cyclooxygenase-2 [COX-2] inhibitors) offered similar efficacy with reduced toxicity, but this promise of gastroduodenal safety has only partially been fulfilled, and is now dented with associated risks of cardiovascular or intestinal complications. Recent advances in basic science and biotechnology have given insights into molecular mechanisms of NSAID-induced gastroduodenal damage beyond COX-2 inhibition. The emergence of newer kinds of NSAIDs should alleviate gastroduodenal toxicity without compromising innate drug efficacy. In this review, novel strategies for avoiding NSAID-associated gastroduodenal damage will be described. [source]

Sequential clot strength analyses following diclofenac in pediatric adenotonsillectomy

PEDIATRIC ANESTHESIA, Issue 11 2007
MAIREAD HEANEY FCARCSI FJFICM
Summary Background:, Tonsillectomy is a common pediatric surgical procedure resulting in significant postoperative pain. There is ongoing controversy as to the most satisfactory analgesic regimen. Nonsteroidal antiinflammatory drugs (NSAIDs) are an alternative to opioids in this setting. NSAID use in tonsillectomy has been shown to be opioid sparing in the recovery period and to have similar analgesic effects to opioids in pediatric patients. Because of their nonspecific action on the enzyme cyclo-oxygenase there is potential for increased bleeding which has led many practitioners to avoid NSAIDs completely in this patient population potentially resulting in suboptimal pain control. Our aim in this study was to assess the effect of preoperatively administered diclofenac on the blood clot strength in children undergoing (adeno-) tonsillectomy. Methods:, Twenty patients undergoing (adeno-) tonsillectomy were recruited into this prospective observational study. All patients received 2 mg·kg,1 of diclofenac rectally immediately preoperatively. Blood was taken for thromboelastograph analysis pre-diclofenac and 1 and 4 h post-diclofenac administration. Results:, There was a statistically significant increase in maximal clot strength (MA) at 1 and 4 h after diclofenac. Similarly there was a statistically significant reduction in time to initial fibrin formation (R time) post-diclofenac. There was no primary or secondary hemorrhage. Conclusions:, Diclofenac when given preoperatively does not adversely affect clot strength in the immediate postoperative period when the risk of primary hemorrhage is greatest. [source]

Effect of non-steroidal anti-inflammatory drugs on non-melanoma skin cancer incidence in the SKICAP-AK trial,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2009
Mary C. Clouser MPH, PhDc
Abstract Recent studies link the prostaglandin metabolic pathway to skin carcinogenesis expanding possibilities that cyclooxygenase (COX) inhibitors may be utilized in non-melanoma skin cancer (NMSC) chemoprevention. Using data from a study of the efficacy of retinol supplementation on incidence of NMSC, we sought to determine the role of non-steroidal anti-inflammatory drugs (NSAIDs) in NMSC development. Cox proportional hazards models describe the relationship between NSAID use and time to first squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) among participants categorized by use pattern: continuous users (use for length of study duration), new users (use for less than study duration), and non-users. For SCC and BCC, there was a statistically significant protective effect for participants who reported use for less than the study duration (HR,=,0.49, 95%CI 0.28,0.87 and HR,=,0.43, 95%CI 0.25,0.73, respectively). Categorical examination of NSAIDs (aspirin (ASA) vs. non-ASA NSAIDs) showed significant effects for BCC among those using non-ASA NSAIDs for less than the study duration (HR,=,0.33, 95%CI 0.13,0.80). For SCC and BCC, NSAID use of shorter duration and potentially more recent, was more protective than longer duration of use. These results are counter to the idea that longer duration of NSAID use is more protective. Additional investigations are needed into the role NSAIDs play in the chemoprevention of NMSC. Copyright © 2009 John Wiley & Sons, Ltd. [source]

The pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4.6 million people,,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2008
Emil Loldrup Fosbøl
Abstract Purpose To describe the nationwide pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in the Danish population. Methods All Danish citizens aged 10 or above 1 January 1997 were included in the study. The national prescription registry was used to identify all claimed prescriptions for NSAIDs by the cohort until 2005. By individual-level-linkage of nationwide registries, information was acquired concerning hospitalizations, comorbidity, concomitant pharmacotherapy and socioeconomic factors. Results The population consisted of 4,614,807 individuals, of which 2,663,706 (57.8%) claimed at least one prescription for NSAID from 1997 to 2005. Ibuprofen and diclofenac were the most frequently used non-selective NSAIDs, whereas rofecoxib and celecoxib were the most frequently used selective cyclooxygenase-2 (COX-2) inhibitors. The usage was similar across all age groups. Female sex and increasing age was associated with increased use of NSAID. Factors predicting extensive NSAID use were: rheumatic disease (odds ratio (OR),=,1.79, 95% confidence interval (CI): 1.69,1.90), gout agents (allopurinol) (OR,=,2.54, CI: 2.44,2.64) and other pain medication (OR,=,3.27, CI: 3.23,3.31). NSAIDs were most often prescribed for use for one distinct treatment interval and for a short period (overall inter-quartile range [IQR]: 9,66 days). High doses were used in a relatively large proportion of the population (8.9% for etodolac to 19.5% for celecoxib) and 54,373 (2.0%) claimed prescriptions for more than one NSAID at the same time. Conclusion NSAIDs were commonly used in the Danish population. Since NSAIDs have been associated with increased cardiovascular risk, further research on the overall risk associated with these drugs on a national scale is needed. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Latest news and product developments

PRESCRIBER, Issue 7 2008
Article first published online: 28 APR 200
Referrals from Boots The majority of people requesting Boots' erectile dysfunction or weight management programmes are referred to their GP(Pharm J 2008;280:297). The programmes are run under patient group directions and exclude people with elevated blood pressure, blood glucose or cholesterol. Over 80 per cent of customers screened for the erectile dysfunction programme in Manchester and two-thirds of those screened for the national obesity programme were referred. Vildagliptin: new DPP-4 inhibitor for diabetes Novartis has introduced the DPP-4 inhibitor vildagliptin for the treatment of type 2 diabetes. Two formulations are available: Galvus (vildagliptin 50mg) is licensed for use with metformin, a sulphonylurea or a thiazolidinedione when these agents do not achieve glycaemic control alone, and Eucreas (vildagliptin 50mg plus metformin 850 or 1000mg) is licensed for patients requiring combined therapy with vildagliptin and metformin. Inhibition of DPP-4 blocks the breakdown of the incretin hormones GIP and GLP-1, reducing fasting plasma glucose and postprandial hyperglycaemia. Vildagliptin is the second DPP-4 inhibitor to be introduced; the first was sitagliptin (Januvia), which has similar licensed indications. The third available drug acting on the incretin system is the incretinmimetic exenatide (Byetta); administered by injection, this is licensed for use with metformin and/or a sulphonylurea and is the only agent in this class to be approved for triple therapy. No comparative trials of these agents have been published. A month's treatment with twice-daily vildagliptin 50mg or either strength of vildagliptin plus metformin costs £31.76. Sitagliptin 100mg once daily costs £33.26. Sinusitis symptoms don't guide treatment The severity and duration of symptoms do not help to identify which patients with sinusitis will be helped by antibiotics, a new meta-analysis suggests (Lancet 2008;371: 908-14). The analysis of patient-level data from nine trials involving a total of 2547 adults showed that the number needed to treat (NNT) to cure one patient with rhinosinusitis was 15. Cure took longer to achieve in older patients and in those reporting symptoms for longer or with more severe symptoms. The authors comment that treatment is not justified given the risk of resistance and adverse effects and cost of antibiotics. Draft guidance from the National Institute for Health and Clinical Excellence (NICE) on the management of respiratory infections states that no antibiotic therapy or a delayed antibiotic prescribing strategy should be negotiated for patients with acute sinusitis. Taking cod liver oil leads to fewer NSAIDs Cod liver oil could help some patients with rheumatoid arthritis to reduce their NSAID consumption, according to a study from Dundee (Rheumatology online: 24 March 2008; doi: 10.1093/rheumatology/ ken024). A total of 97 patients were randomised to nine months' treatment with cod liver oil 10g per day or placebo. After 12 weeks, patients attempted to reduce or stop their use of NSAIDs. Significantly more of those taking cod liver oil achieved at least a 30 per cent reduction in NSAID use compared with placebo (39 vs 10 per cent). There were no differences in adverse effects or disease activity. Welsh prescriptions up The reduction in the prescription charge in Wales in 2004 was followed by an increase in prescribing of nonsedating antihistamines in wealthier areas, a study suggests (Health Policy online: 5 March 2008; doi:10.1016/j. healthpol.2008.01.006). In the two years preceding the cut, prescriptions for nonsedating antihistamines increased by about 7 per cent; in the two years after the cut, the increase was nearly 14 per cent. By contrast, there was no change in the rate of increase in the south-east of England (4,5 per cent in both periods). The increased growth in prescribing was statistically significant in the five least deprived but not in the five most deprived health boards in Wales. Aspirin linked with reduced asthma risk Low-dose aspirin is associated with a reduced risk of developing asthma, a new analysis of the Women's Health Study has shown (Thorax online: 13 March 2008; doi:10.1136/ thx.2007.091447). The analysis included 37 270 women with no asthma at baseline who were randomised to take placebo or aspirin 100mg every other day. After 10 years, 872 cases of asthma occurred in women taking aspirin and 963 with placebo, a 10 per cent reduction in risk. However, risk was not reduced in obese women. The mechanism by which aspirin may affect the risk of asthma is unknown. The latest evidence is consistent with findings published by the same investigators after analysis of two other large observational studies, the Physicians' Health Study and the Nurses Health Study. Anastrozole bone loss Long-term follow-up of the ATAC (Anastrozole, Tamoxifen, Alone or in Combination) trial has confirmed that adjuvant therapy with anastrozole (Arimidex) is associated with greater loss of bone mineral density (BMD) than tamoxifen in postmenopausal women with invasive primary breast cancer (J Clin Oncol 2008;26: 1051,7). After five years, median BMD was reduced by 6 and 7 per cent in the lumbar spine and hip with anastrozole compared with approximately 3 and 1 per cent respectively for tamoxifen, though no patients developed osteoporosis. Copyright © 2008 Wiley Interface Ltd [source]

Latest news and product developments

PRESCRIBER, Issue 6 2007
Article first published online: 8 JUN 200
Initial macrolide better for pneumonia? An observational study has suggested that initial treatment with a macrolide antibiotic (such as erythromycin) may be more effective than a fluoroquinolone (like ciprofloxacin) or tetracycline as initial treatment for community acquired pneumonia and bacteraemia (Chest 2007;131:466-73). The US review of 2209 hospital episodes found that macrolide therapy was associated with a 40 per cent lower risk of death during hospital stay or within 30 days and of hospital readmission within 30 days of discharge. By contrast, no such benefit was apparent with fluoroquinolones or tetracycline. Two-year safety data for inhaled insulin Compared with sc insulin, inhaled insulin (Exubera) is associated with a small early decrease in lung function in the first three months of therapy but no further difference for up to two years (Diabetes Care 2007;30: 579-85). The comparative trial found that FEV1 declined at a mean rate of 0.051 litres per year with inhaled insulin and 0.034 litres per year with sc insulin, but there was no significant difference in the rates of decline after three months. Inhaled insulin was associated with a higher incidence of cough (37.6 vs 13.1 per cent) but a lower incidence of severe hypoglycaemic events (2.8 vs 4.1 events per 100 subject- months) and mean weight gain was 1.25kg less. Fracture risk warning with rosiglitazone GlaxoSmithKline has warned US prescribers that rosiglitazone may be associated with an increased risk of fractures. The company says information for prescribers in Europe will follow shortly. The warning comes from the ADOPT study (N Engl J Med 2006;355:2427-43), which found a significantly higher incidence of fractures of the humerus, hand and foot among women taking rosiglitazone (9.3 per cent) than with metformin (5.1 per cent) or glibenclamide (3.5 per cent). There was no difference in fracture incidence among men. The company recommends that fracture risk should be considered for women taking or about to take rosiglitazone. Oral treatment for grass pollen allergy A new treatment for allergic rhinitis due to grass pollen allergy has been introduced by ALK-Abelló. Grazax is a sublingual tablet containing a stan-dardised dose of allergen from the pollen of timothy grass. Treatment should be initiated by a specialist four months before the onset of the allergy season and continued throughout the season. Adverse effects include oral and ear pruritus, nasopharyngitis and mouth oedema. A month's treatment at the recommended dose of one tablet daily costs £67.50. Frequent analgesics linked with hypertension Men who take analgesics regularly have an increased frequency of hypertension, a US study has shown (Arch Intern Med 2007;167:394-9). The US Health Professionals Follow-Up study evaluated the use of NSAIDs, paracetamol and aspirin in 16 031 men with normal blood pressure and followed them up for four years. Compared with those who did not report analgesic use, the risk of hypertension was increased by 38 per cent for NSAID use, 34 per cent for paracetamol and 26 per cent for aspirin, all for for six or seven days a week. Similar risks were found when anal- gesic use was determined according to the number of tablets taken. The authors acknowledge the increased risk is modest, but point out that the implications may nonetheless be important because analgesics are widely used. Multiples do most pharmacist MURs Uptake of medicines use reviews (MURs) by pharmacists was modest in 2005 and most reviews were carried out by pharmacy chains rather than independent contractors, a new study has shown (Pharm J 2007;278:218-23). The survey of PCTs and SHAs in England and Wales found that, although 38 per cent of community pharmacies claimed payments for the service, 84 per cent of MURs were carried out by pharmacy chains. Uptake was low, amounting to only 7 per cent of the maximum possible number of MURs. Patients see information needs differently There is a mismatch in the perceptions of patients and health professionals about the purpose of written information about medicines, a systematic review has concluded (Health Technol Assess 2007;11:1-178). Some health professionals believe the main purpose of information is to promote compliance, whereas patients want information to help them make decisions about their treatment, including not taking it. In particular, patients want information on adverse effects, but health professionals have reservations about providing it. Aspirin for all women over 65? All women over 65 should take low-dose aspirin if the benefits are likely to outweigh the risk of adverse effects, according to new guidelines from the American Heart Association on preventing cardiovascular disease in women (published online 19 Feb 2007;doi: 10.1161/circulationaha.107.181546). The guidelines have moved away from the long-established Framingham model of risk assessment to categorising three levels of risk: high (heart disease or other relevant disease present), at risk (at least one risk factor) and optimal (healthy lifestyle, no risk factors). Low-dose aspirin is recommended for all women at high risk, for women aged 65 or over when reducing the risk of MI or ischaemic stroke outweighs the risk of adverse effects, and for younger women when reducing the risk of ischaemic stroke outweighs that of toxicity. Combination inhaler therapy Combining an inhaled long-acting bronchodilator with a steroid reduces COPD exacerbations but not all-cause mortality, a three-year trial has shown (N Engl J Med 2007;356:775-89). However, inhaled steroids appear to increase the risk of pneumonia. The TORCH trial randomised 6112 patients (FEV1<60 per cent predicted) to treatment with salmeterol 50µg plus fluticasone 500µg (Seretide) twice daily, salmeterol (Serevent) or fluticasone (Flixotide) as monotherapy, or placebo. All-cause mortality rates were 12.6, 13.5, 16.0 and 15.2 per cent respectively; the risk of death was 17 per cent lower with combined therapy, but the difference did not reach statistical significance. The combination reduced the incidence of exacerbations by 25 per cent and improved health status and FEV1. Use of fluticasone was not associated with more ocular or bone disorders, but there was an increased incidence of pneumonia among users (19.6 per cent with combined therapy and 18.3 per cent with fluticasone vs 12.3 per cent with placebo). Seretide is currently licensed in the UK for use in patients with FEV1 <50 per cent predicted. Tamoxifen long- term benefits Women with breast cancer who take tamoxifen for five to eight years continue to have a lower risk of recurrence for 10-20 years, long-term follow-up of two blinded trials has shown (J Nat Cancer Inst 2007; 99:258-60, 272-90). The frequency of adverse effects was markedly reduced when treatment ended, changing the balance of risk and benefit. Copyright © 2007 Wiley Interface Ltd [source]

Latest news and product developments

PRESCRIBER, Issue 11 2006
Article first published online: 14 SEP 2010
NSAIDs linked to erectile dysfunction Use of NSAIDs may double the risk of erectile dysfunction, according to an observational study from Finland (J Urol 2006;175:1812-6). A survey of 1683 men aged 50-70 showed that, over a five-year period, the incidence of erectile dysfunction was 93 per 1000 person-years of NSAID use compared with 35 per 1000 person-years in nonusers. After controlling for risk factors and compared with nonusers of NSAIDs who did not have arthritis, the relative risk was greater in NSAID users whether they had arthritis (1.9, 95% CI 1.2-3.1) or not (2.0, 95% CI 1.2-3.5). The risk was somewhat higher in nonusers with arthritis (1.3, 95% CI 0.9-1.8). Inhaled steroids do not modify asthma course Fluticasone does not ameliorate the course of asthma in young children, say US investigators (N Engl J Med 2006;354:1985-97). Fluticasone 88,g twice daily controlled symptoms for two years in 285 children aged two to three. However, in the following treatment-free year there were no differences from placebo in asthma-free days, lung function or exacerbation frequency. Fluticasone was associated with a 1.1cm reduction in growth during treatment, though this decreased to 0.7cm after a year without treatment. A second study (N Engl J Med 2006;354:1998-2005) found that introducing an inhaled steroid after a three-day episode of wheezing in one-month-old infants did not prevent the development of persistent wheezing in the first three years of life. Prescribing for fracture prevention increases Prescribing of medicines to reduce fracture risk in post-menopausal women has tripled in the last five years, according to a PPA prescribing review (www.ppa.org.uk/news/pact-052006.htm). The change predates NICE guidance on secondary prevention, published in 2005. Approximately 480 000 women in the UK receive treatment. Alendronic acid accounts for almost a third of prescriptions and half of the £45 million spent in the last quarter of 2005. There was a two-fold variation in prescribing costs between strategic health authorities. Pharmacist prescribing for hypertension A survey of patients attending a pharmacist-led clinic for hypertension has found overwhelming support for pharmacist prescribing (Pharm J 2006;276:567-9). All 127 patients offered an appointment at a hypertension clinic run by pharmacist supplementary prescribers were surveyed; the response rate was 87 per cent. Eighteen respondents chose not to attend, of whom five preferred their usual medical care. Responses from 88 patients revealed that 57 per cent believed the standard of care was better than previously, and 86 per cent said they now understood more about their condition, felt more involved in treatment decisions and were able to make an appointment easily. Ninety-two per cent considered pharmacist supplementary prescribing a good idea. Anti-TNFs linked to malignancy/infections The anti-TNF monoclonals infliximab (Remicade) and adalimumab (Humira) are associated with an increased risk of cancer and serious infections in patients with rheumatoid arthritis (JAMA 2006;295:2275-85). A meta-analysis of nine randomised trials involving 3493 treated patients showed that, compared with placebo, these agents were associated with an odds ratio (OR) of 3.3 (95% CI 1.2-9.1) for malignancy, and there was evidence of a dose-response effect. The number needed to harm (NNH) for one additional malignancy in 6-12 months' treatment was 154. There was also an increased risk of serious infection (OR 2.0; 95% CI 1.3-3.1), for which the NNH was 59 for one case in 3-12 months' treatment. The authors say that the findings were based on low numbers of events and should be interpreted cautiously. Travelling abroad with CDs Aintree Hospitals NHS Trust has published a guide to help patients who travel abroad while taking controlled drugs (www.aintree hospitals.nhs.uk/publications/file.aspx?int_version_id=912). The leaflet explains the need for a licence and provides contact details for relevant organisations. New PCTs announced The government has announced the long-awaited reorganisation of PCTs in England (www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleases Notices/fs/en?CONTENT_ID=4135001&chk=j12UcL). The current total will be reduced from 303 to 152 from 1 October. More than 70 per cent will be co-terminous with local authorities in the hope that services will be delivered more efficiently. The changes will reduce administrative costs, with anticipated savings of £250 million in the next two years. The reorganisation of PCTs follows a restructuring of strategic health authorities and was the subject of a major public consultation exercise in 2005/06. There will also be a reorganisation of ambulance trusts, reducing the number from 29 to 12. Regional maps of the new PCT boundaries are available atwww.dh.gov.uk/ NewsHome/NewsArticle/fs/en?CONTENT_ID=4135088&chk=oJufTo. New and updated guides New medicines guides for GI disease have been published by the Medicines Information Project at http://medguides.medicines.org.uk. PRODIGY has issued 11 updated and five new full guides and has also updated five of its quick reference guides (www.prodigy.nhs.uk). [source]

Comparison of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors use in Australia and Nova Scotia (Canada)

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 1 2009
Nadia Barozzi
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT , Cyclo-oxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. WHAT THIS STUDY ADDS , The study showed that there were similarities in the anti-inflammatory prescribing pattern between Australia and Nova Scotia; however, volumes of both ns-NSAIDs and COX-2 inhibitors prescribed were higher in Australia in the study period. The remarkable increase observed in Australia in NSAIDs use was essentially due to the much higher COX-2 inhibitor use. Differences in regulatory and marketing practices, as well as cultural and historical differences might be some of the reasons for differences in the NSAID prescribing between Australia and Nova Scotia. AIMS Cyclooxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. The objectives of this study were to compare and contrast COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drug (ns-NSAID) use in Nova Scotia (Canada) and Australia and to identify lessons learned from the two jurisdictions. METHODS Ns-NSAID and COX-2 inhibitor Australian prescription data (concession beneficiaries) were downloaded from the Medicare Australia website (2001,2006). Similar Pharmacare data were obtained for Nova Scotia (seniors and those receiving Community services). Defined daily doses per 1000 beneficiaries day,1 were calculated. COX-2 inhibitors/all NSAIDs ratios were calculated for Australia and Nova Scotia. Ns-NSAIDs were divided into low, moderate and high risk for gastrointestinal side-effects and the proportions of use in each group were determined. Which drugs accounted for 90% of use was also calculated. RESULTS Overall NSAID use was different in Australia and Nova Scotia. However, ns-NSAID use was similar. COX-2 inhibitor dispensing was higher in Australia. The percentage of COX-2 inhibitor prescriptions over the total NSAID use was different in the two countries. High-risk NSAID use was much higher in Australia. Low-risk NSAID prescribing increased in Nova Scotia over time. The low-risk/high-risk ratio was constant throughout over the period in Australia and increased in Nova Scotia. CONCLUSIONS There are significant differences in Australia and Nova Scotia in use of NSAIDs, mainly due to COX-2 prescribing. Nova Scotia has a higher proportion of low-risk NSAID use. Interventions to provide physicians with information on relative benefits and risks of prescribing specific NSAIDs are needed, including determining their impact. [source]

Calcium, dietary, and lifestyle factors in the prevention of colorectal adenomas

CANCER, Issue 3 2007
Eric A. Miller PhD
Abstract BACKGROUND. Many studies have suggested a role for calcium in reducing the risk of colorectal adenomas and cancer but its effectiveness may be dependent on interactions with other dietary and/or lifestyle factors. We examined the association between calcium and prevalence of adenomas and assessed whether the association was stronger in biologically plausible subgroups. METHODS. Cross-sectional data from 222 cases and 479 adenoma-free controls who underwent colonoscopies and completed food frequency and lifestyle questionnaires were used in the analyses. Multivariable logistic regression was used to estimate the association between calcium and prevalence of adenomas. Stratified analyses and the likelihood ratio test were used to examine effect modification by various demographic, lifestyle, and behavioral factors. RESULTS. Overall, little association was observed comparing total calcium intake of ,900 mg/day to <500 mg/day (adjusted odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.53,1.37). However, stronger associations were observed in patients with lower fat intake and in those who regularly (,15 times/month) took nonsteroidal antiinflammatory drugs (NSAIDs). Specifically, total calcium intake of ,900 mg/day was associated with a lower prevalence of adenomas among patients with lower fat intake (OR = 0.47, 95% CI: 0.25,0.91) but not among those with higher fat intake (OR = 1.20, 95% CI: 0.61,2.35; P -value for interaction = .01). For NSAIDs, the associations were OR = 0.37 (95% CI: 0.16,0.86) for regular NSAID users and OR = 1.27 (95% CI: 0.73,2.22) with infrequent or nonuse of NSAIDs, respectively (P = .06). CONCLUSIONS. The data suggest that a lower-fat diet and regular NSAID use may enhance calcium's effectiveness as a colorectal cancer preventive agent. Cancer 2007 © 2007 American Cancer Society. [source]

What happened to the prescribing of other COX-2 inhibitors, paracetamol and non-steroidal anti-inflammatory drugs when rofecoxib was withdrawn in Australia?,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2007
Nadia Barozzi
Abstract Objectives To analyse how the prescribing of cyclooxygenase-2 (COX-2) inhibitors, non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) and paracetamol (acetaminophen) changed when rofecoxib was withdrawn in 2004. Method COX-2 inhibitors, paracetamol and ns-NSAID's use was measured using dispensing data for concession beneficiaries subsidized by the Australian Pharmaceutical Benefit Scheme (PBS) for the period of 1997,2005. Data were downloaded from the Medicare Australia website and converted, according to the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) (2005), to DDD/1000 concession beneficiaries/day. Results In the period 2000,2004, the use of COX-2 inhibitors was progressively increased. Overall NSAID's use changed from approximately 80 to 105,DDD/1000 concession beneficiaries/day while a decrease of ns-NSAIDs from about 70 to 40,DDD/1000 concession beneficiaries/day was observed. Following rofecoxib withdrawal, the overall NSAIDs use declined. In 2005, celecoxib prescription declined (23%) while prescription of meloxicam increased by 62%. Use of paracetamol was steady over the period 1997,2004 (around 40,DDD/1000 concession beneficiaries/day). In April 2005, a slight increase in paracetamol use was observed. Conclusion Our analysis showed that COX-2 inhibitors prescribing markedly influenced the overall NSAIDs prescribing in Australia. When COX-2 inhibitors were introduced their uptake was rapid and extensive. Following rofecoxib withdrawal, the total overall dispensing of NSAIDs returned to a similar value as before COX-2 inhibitors' introduction. The decrease was due both to rofecoxib withdrawal and to a reduction in celecoxib prescribing. However, meloxicam use increased. Paracetamol prescribing was steady, between 1997 and 2005 and was not affected when the COX-2 inhibitors were introduced on to the market and after rofecoxib withdrawal, rather than increasing as might have been anticipated after rofecoxib withdrawal. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Onset of acute myocardial infarction after use of non-steroidal anti-inflammatory drugs,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008
Tarek A. Hammad MD
Abstract Purpose To examine the association between cyclooxygenase-2 (COX-2) selective and traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and incident acute myocardial infarction (AMI), and to address unanswered questions regarding the contour of risk over time. Methods A cohort of new NSAID users aged 40,84 years was followed for the occurrence of first AMI. Data were collected within the General Practice Research Database (GPRD) from 1 January 1997 to 31 December 2004. Results The study population included 1185 AMI events (889 probable and 296 possible) from a cohort of 283,136 patients. After adjustment for demographic and cardiovascular risk factors, the hazard ratio (HR) for AMI was significantly increased for both coxib (2.11, 95% confidence interval (CI) 1.04,4.26) and non-coxib (2.24, 95%CI 1.13,4.42) COX-2 selective NSAIDs when compared to remote exposure to NSAIDs, but was not increased for traditional NSAIDs. Stratifying exposure into the first month of use versus use beyond 1 month, the risk of AMI was increased during the first month of COX-2 selective NSAIDs use, but not later (3.43, 95%CI 1.66,7.07 and 1.88, 95%CI 0.82,4.31, respectively p -value for interaction,=,0.6). Conclusions The results suggest that the use of coxib and non-coxib COX-2 selective NSAIDs was associated with an elevated risk of AMI within the first month of exposure. Recent past exposure to NSAID was not associated with a similar increase in risk. Copyright © 2008 John Wiley & Sons, Ltd. [source]

What happened to the prescribing of other COX-2 inhibitors, paracetamol and non-steroidal anti-inflammatory drugs when rofecoxib was withdrawn in Australia?,