Home About us Contact
|
Home About us Contact | ||
|
|
||
Over-the-counter Medications (over-the-counter + medication)
Selected AbstractsPharmacotherapy of allergic rhinitis: a pharmaco-economic approachALLERGY, Issue 1 2009S. Simoens This article reports on a systematic literature review of the costs of allergic rhinitis (AR), the economic value of pharmacotherapy of AR, and the factors affecting costs and economic value of pharmacotherapy. Included studies had carried out a cost-of-illness analysis, cost analysis, cost-effectiveness, cost-utility or cost-benefit analysis. Allergic rhinitis imposes a substantial economic burden on society, with indirect costs of productivity loss being larger than the direct healthcare costs. Cost estimates were biased because of difficulties of diagnosis; exclusion of patients who do not seek healthcare; exclusion of over-the-counter medication; difficulties in estimating productivity loss. There is limited evidence on costs of seasonal/perennial and intermittent/persistent AR. Little is known of the economic value of pharmacotherapy of AR, although levocetirizine appears to be cost-effective as compared with placebo. Economic evaluations suffered limitations from small sample sizes, short trial duration, lack of standardized effectiveness measure, restricted scope of costs. Finally, the economic value of pharmacotherapy of AR is influenced by the perspective of the economic evaluation, relative effectiveness and costs of available drugs, patient compliance with treatment. [source] Overview of treatment of acute migraineDRUG DEVELOPMENT RESEARCH, Issue 7 2007Arthur H. Elkind Abstract Acute migraine is a major public health problem with a significant economic burden secondary to short-term disability and absenteeism. Treatment of acute migraine is always challenging for primary care physicians and family practitioners, as there are no set universal guidelines for the treatment of acute migraine. In acute migraine treatment, nonsteroidal anti-inflammatory drugs (NSAIDs), migraine-specific medications, and adjunctive medications are used, depending on the severity of acute migraine attacks. Treatment of acute migraine has changed drastically since the introduction of the triptans. However, even after the introduction of triptans, nearly one-half of migraine sufferers are still being treated with over-the-counter medications. In this literature review, we mention drugs that are being used in the treatment of acute migraine and their level of evidence recommended by the U.S. Headache Consortium. This article gives special emphasis to pharmacokinetics and clinical characteristics of all available triptans. Drug Dev Res 68:441,448, 2007. © 2008 Wiley-Liss, Inc. [source] Impact of US and Canadian precursor regulation on methamphetamine purity in the United StatesADDICTION, Issue 3 2009James K. Cunningham ABSTRACT Aims Reducing drug purity is a major, but largely unstudied, goal of drug suppression. This study examines whether US methamphetamine purity was impacted by the suppression policy of US and Canadian precursor chemical regulation. Design Autoregressive integrated moving average (ARIMA)-intervention time,series analysis. Setting Continental United States and Hawaii (1985,May 2005). Interventions US federal regulations targeting precursors, ephedrine and pseudoephedrine, in forms used by large-scale producers were implemented in November 1989, August 1995 and October 1997. US regulations targeting precursors in forms used by small-scale producers (e.g. over-the-counter medications) were implemented in October 1996 and October 2001. Canada implemented federal precursor regulations in January 2003 and July 2003 and an essential chemical (e.g. acetone) regulation in January 2004. Measurements Monthly median methamphetamine purity series. Findings US regulations targeting large-scale producers were associated with purity declines of 16,67 points; those targeting small-scale producers had little or no impact. Canada's precursor regulations were associated with purity increases of 13,15 points, while its essential chemical regulation was associated with a 13-point decrease. Hawaii's purity was consistently high, and appeared to vary little with the 1990s/2000s regulations. Conclusions US precursor regulations targeting large-scale producers were associated with substantial decreases in continental US methamphetamine purity, while regulations targeting over-the-counter medications had little or no impact. Canada's essential chemical regulation was also associated with a decrease in continental US purity. However, Canada's precursor regulations were associated with purity increases: these regulations may have impacted primarily producers of lower-quality methamphetamine, leaving higher-purity methamphetamine on the market by default. Hawaii's well-known preference for ,ice' (high-purity methamphetamine) may have helped to constrain purity there to a high, attenuated range, possibly limiting its sensitivity to precursor regulation. [source] Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication UseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Holly M. Holmes MD OBJECTIVES: To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia. DESIGN: Medication data were obtained using chart review. Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel. SETTING: Three long-term care facilities. PARTICIPANTS: Thirty-four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use. Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel. MEASUREMENTS: Prescription and over-the-counter medications were recorded for the 34 patients. Following the modified Delphi process, medications were characterized into one of four categories for use in palliative care patients with advanced dementia: never appropriate, rarely appropriate, sometimes appropriate, or always appropriate. RESULTS: Patients were taking an average of 6.5 medications at enrollment. Six patients were taking 10 or more medications daily. Consensus was reached ranking the appropriateness of 69 of 81 medication classes for patients with advanced dementia. Overall, 5% of the 221 medications prescribed at enrollment were considered to be never appropriate, and 10 of 34 patients (29%) had been taking a medication considered to be never appropriate. CONCLUSION: Based on these preliminary findings, consensus criteria for prescribing in advanced dementia are needed to decrease polypharmacy and reduce the use of medications that are of minimal benefit or high risk. [source] Annual Direct and Indirect Health Costs of the Congenital IchthyosesPEDIATRIC DERMATOLOGY, Issue 4 2010Andrew R. Styperek M.B.A. We conducted a cost analysis through an online survey posted on the Foundation for Ichthyosis and Related Skin Types Website. We assessed cutaneous disease severity, via the previously validated Congenital Ichthyosis Severity Index (CISIÔ), demographics, and CI type. We estimated direct health care costs: prescription and over-the-counter medications, outpatient visits, and emergency department and hospital visit costs; and indirect costs: earnings lost owing to absences from work because of CI-related illness. The CI subjects of our study (n = 224) consumed a mean (SD) of $3,192 ($7,915) annually. Direct costs accounted for 90%, whereas indirect costs accounted for 10%. These costs resulted in an estimated annual cost of $37MM/year (excluding ichthyosis vulgaris) of which $17MM is borne out-of-pocket by patients. Depending on the CI diagnosis, patients were responsible for 30,51 cents of every dollar of mean annual medical care costs. Our estimated annual CI costs are comparable to cutaneous lymphoma. More effective treatments for CI would help minimize this burden. Traditional insurance products do not appear to substantially alleviate the financial burden of disease, as a significant amount is from out-of-pocket expenses. [source] Does inhaling menthol affect nasal patency or cough?,PEDIATRIC PULMONOLOGY, Issue 6 2008MRCPCH, Priti Kenia MD (Paediatrics) Abstract Objective There is widespread use of menthol in over-the-counter medications, despite scant information on any beneficial effects. Our aim was to assess the effect of menthol on nasal air flow, perception of nasal patency and cough challenge testing. Materials and Methods Subjects comprised 42 healthy children aged 10 and 11 in a school setting. We used a single-blind pseudo-randomized cross-over trial to compare the effect of an inhalation of either menthol or placebo(eucalyptus oil). Baseline and post-intervention measurements were made on each of 2 consecutive days. Main outcome measures were (i) nasal expiratory and inspiratory flows and volumes, measured by spirometer, (ii) perception of nasal patency, assessed with a visual analogue scale (VAS), and (iii) the number of coughs in response to nebulized citric acid. Results There was no effect of menthol on any of the spirometric measurements. Following menthol, there was a significant increase in the perception of nasal patency (mean difference in log VAS (menthol-placebo),=,,0.207, 95%CI ,0.329, ,0.085). The cough count after menthol inhalation was reduced when compared to baseline but the change was not different from that after placebo (mean difference in cough count (menthol-placebo),=,,1.71, 95%CI ,4.11, 0.69). Conclusion Menthol has no effect on objective measures of flow but significantly increases the perception of nasal patency. It may not be possible to extrapolate these findings to younger children and those with rhinitis. Extending the study of menthol to these groups, including investigations of the efficacy and safety profiles, will provide further valuable evidence for its common use. Pediatr Pulmonol. 2008; 43:532,537. © 2008 Wiley-Liss, Inc. [source] Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2006Sebastian Schneeweiss MD Abstract Background Large health care utilization databases are frequently used to analyze unintended effects of prescription drugs and biologics. Confounders that require detailed information on clinical parameters, lifestyle, or over-the-counter medications are often not measured in such datasets, causing residual confounding bias. Objective This paper provides a systematic approach to sensitivity analyses to investigate the impact of residual confounding in pharmacoepidemiologic studies that use health care utilization databases. Methods Four basic approaches to sensitivity analysis were identified: (1) sensitivity analyses based on an array of informed assumptions; (2) analyses to identify the strength of residual confounding that would be necessary to explain an observed drug-outcome association; (3) external adjustment of a drug-outcome association given additional information on single binary confounders from survey data using algebraic solutions; (4) external adjustment considering the joint distribution of multiple confounders of any distribution from external sources of information using propensity score calibration. Conclusion Sensitivity analyses and external adjustments can improve our understanding of the effects of drugs and biologics in epidemiologic database studies. With the availability of easy-to-apply techniques, sensitivity analyses should be used more frequently, substituting qualitative discussions of residual confounding. Copyright © 2006 John Wiley & Sons, Ltd. [source] MotherSafe: Review of three years of counselling by an Australian teratology Information ServiceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Joy Marie LIM Background: MotherSafe was established in January 2000 at the Royal Hospital for Women as Australia's first ,purpose-built' Teratogen Information Service and since then has received over 75 000 calls regarding exposures during pregnancy and lactation. Aim: To describe the patterns of use of MotherSafe over a three-year period. Methods: Retrospective descriptive epidemiological study using data from the database established at MotherSafe. Records from all the calls logged at MotherSafe between January 2005 and December 2007 were analysed to determine total number of calls, demographic characteristics of callers, including age, caller category and postcode, reason for call, source of referral and type of exposure. Results: A total of 47 138 calls were recorded to the MotherSafe service from January 2005 to December 2007. The majority of calls were regarding exposures in pregnancy (55%) and breast-feeding (38%). Average age of patients was 32.3 years. Of the calls made, 81.9% (38 485 of 46 968) were by consumers (the pregnant or lactating woman herself or a relative). The most common primary exposure categories were: over-the-counter medications (11.3%), psychotropic medication (9.0%), herbal or vitamin products (8.2%), antibiotics (7.0%), gastrointestinal medications (6.8%) and topical products (6.6%). Forty per cent of callers enquired about multiple exposures. Conclusions: The utilisation of MotherSafe by consumers and general practitioners continues to increase, reflecting the strong demand for a teratogen counselling service that provides high-quality, evidence-based information on exposures during pregnancy and lactation. [source] | ||||||||||