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ASCOT and Other Studies Show Some Surprising Findings [Jul. 6th, 2008|10:52 am]

Chronic Pain Associated With Increased Prevalence of Hypertension

Chronic pain may be associated with an increased risk of hypertension, and early and aggressive management of chronic pain may have a beneficial impact on cardiovascular disease in this population, according to the results of a study from Vanderbilt University School of Medicine, Nashville, Tennessee.[5]

In healthy people, raised blood pressure is known to be associated with decreased sensitive-to-acute pain, but in individuals with chronic pain, such as chronic low back pain or chronic orofacial pain, elevated blood pressure is associated with increased acute pain responsiveness. Stephen Bruehl, PhD, and colleagues[5] speculated that this difference reflects failure of overlapping systems modulating pain and blood pressure. They conducted a retrospective review on randomly selected records of 300 patients with chronic pain evaluated at a university tertiary care pain center and 300 "nonpain" internal medicine patients seen at the same institution. The pain group patients, all aged < 65 years, had been evaluated for pain etiology, location, and duration, use of medications, clinical diagnosis of hypertension, and family history of hypertension. The nonpain group had no history of chronic pain or chronic headaches.

Statistical analysis revealed a significantly higher overall hypertension prevalence in the pain group compared with the nonpain group (39.3% vs 21.0%, P < .001), reflected by a similar significantly greater proportion of patients in the pain group taking antihypertensive medications compared with those in the nonpain group (35.7% vs 18.3%, P < .001). Similar differences were seen between the men and women in each group, although the difference between the women was twice as great compared with the men. Compared with prevalence of clinical hypertension in the US general population, according the third National Health and Nutrition Examination Survey (NHANES III),[6] there was no difference among men and women in the nonpain group, but in the pain group hypertension prevalence was significantly higher.

Chronic pain intensity, but not pain duration, was found to be a predictor of hypertension status, independent of the traditional risk factors for hypertension, such as older age, African American race, and a family history of hypertension.

Bruehl and colleagues[5] speculate that the association between elevated blood pressure levels and chronic pain reflects fundamental alterations in the relationship between the cardiovascular and pain regulatory systems in patients with chronic pain, possibly mediated by central alpha-2 adrenergic activity. Although a large proportion of the patients with chronic pain were taking antidepressant medications, they dismiss these as a possible cause of hypertension, as similar percentages of patients with and without hypertension in this group were taking these medications (55% and 40%, respectively). Another reason for excluding antidepressants as a possible cause of hypertension in this group is that they are more likely to be associated with hypotensive effects according to previous studies, the researchers note. However, they may have increased the likelihood of obesity, which could have contributed indirectly to the relationship between chronic pain and hypertension.

Bruehl and colleagues[5] point out that epidemiologic studies have reported that as many as 14% of the US population may be suffering from chronic pain,[7] so that even a small influence of chronic pain on hypertension could have a meaningful clinical impact.  Printer- Friendly Email This

Medscape Cardiology.  2005;9(1) ©2005 Medscape
This is a part of article ASCOT and Other Studies Show Some Surprising Findings Taken from "Viagra Levitra" Information Blog

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Treatment Strategies for Type 2 Diabetes [Jul. 3rd, 2008|09:49 pm]

Sulfonylureas and Repaglinide

Actions of Sulfonylureas and RepaglinideTwo currently available classes of medications that work by in-creasing insulin secretion from the pancreas are the sulfonylureas and the meglitinide repaglinide, a new-er agent. One of the major advantages of sulfonylureas is that these drugs have the capacity to act quickly in responsive patients, generally within a few days of the start of therapy. This is in contrast to metformin and thiazolidinediones, which may take up to several weeks to generate a therapeutic response. Given the time frame within which most patients have had long-standing hyperglycemia, however, it is unusual that correction needs to be so rapid. Ap- proximately 50% of patients with newly diagnosed type 2 diabetes achieve acceptable glycemic control using sulfonylureas, and the primary nonresponder rate is about 15% to 20%. Sulfonylureas work best early in the course of diabetes, when ß-cell function is still sufficient to respond to the stimulation of insulin secretion promoted by these drugs.[19]

Clinical Effects of SulfonylureasSulfonylureas have been used for decades in the United States and can be an effective treatment mo-dality for glycemic regulation. However, these drugs do not directly alleviate the block to insulin action characteristic of the underlying insulin resistance in type 2 diabetes. Evidence is scant to support claims that sulfonylureas have ex-trapancreatic effects; if such effects exist, they would most likely occur secondary to a reduction in glu-cotoxicity once glycemic control improves.

Adverse Effects of SulfonylureasThe practical clinical disadvantages of sulfonylureas include the significant risk of hypoglycemia, especially when diabetes is well-controlled, and the tendency to cause weight gain. There is long-term therapeutic failure in 30% of patients, due to a loss of ß-cell responsiveness as the severity of type 2 diabetes progresses over time.[20] There are long-standing but unproven concerns that the use of sulfonylureas may be associated with increased cardiovascular risk, due to their effects on certain potassium channels in vascular tissues as well as the pancreatic islets. However, the UKPDS demonstrated that there were no adverse effects distinguishing sulfonylureas from other treatments in the intensively treated cohort.[8]

Available SulfonylureasThe many sulfonylurea agents currently available differ in their clinical potency and recommended dose range (Table 8). The longer-acting sulfonylureas with once-a-day dosing that are widely used include the glipizide sustained-release (GITS) system (Glucotrol XL) and glimepiride (Amaryl).[21] It is important to consider that the dose of any sulfonylurea agent should be in-creased only to the middle of the FDA-approved dose range, since essentially all of the clinical benefit is realized at that point.

RepaglinideRepaglinide (Prandin) is in a new class of agents that rapidly elicit an insulin secretion response following an oral dose. This profile of action potentially allows closer control of postprandial glucose excursions. Since patients are directed not to take repaglinide when they choose to skip a meal as part of a dietary plan, they can avoid hypoglycemia that might occur with a long-acting sulfonyl-urea under similar circumstances. While this dosing schedule is recommended for the pharmacologic action of the drug, some patients find it inconvenient to remember to take multiple doses of medications during the course of the day.

Repaglinide is indicated as monotherapy or in combination with metformin. Because of its similar mechanism of action, repaglinide should not be taken along with sulfonylureas. Repaglinide is taken from 0 to 30 minutes before meals (two to four times per day) in a recommended dose range from 0.5 to 4 mg, to a maximum of 16 mg/d. As with other oral agents for treatment of diabetes, repaglinide should be used cautiously in patients with impaired liver function.[22]

Previous PageSection 6 of 12Drug Benefit Trends 11(11sb):11-34, 1999. © 1999 Cliggott Publishing, Division of SCP Communications
This is a part of article Treatment Strategies for Type 2 Diabetes Taken from "Glimepiride Amaryl Tablets" Information Blog

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Clinical Significance of Targeting Postprandial Hyperglycemia [Jul. 3rd, 2008|03:50 pm]

Pathophysiology of Type 2 Diabetes

In healthy individuals, normal insulin secretion in response to intravenous glucose follows a biphasic pattern.[2] A rapid, sharp release of insulin into the portal circulation starts within minutes of glucose administration, lasts for about 10 min, and is followed by a slower and more prolonged phase of insulin release that begins at 10 min and lasts between 60 and 120 min.[2] Critical to the regulation of prandial and postprandial glycemia, the first phase of insulin secretion inhibits hepatic glucose production early in the absorptive state, whereas the second phase of secretion attenuates postprandial excursions by promoting glucose uptake by peripheral tissues.[2] Figure 1 illustrates the normal insulin response to an intravenous glucose tolerance test.[2] In individuals with type 2 diabetes, who have insulin resistance, the insulin secretory response can initially compensate for the insulin resistance; however, eventually, first-phase insulin secretion is lost, and second-phase secretion is impaired, causing postpran-dial hyperglycemia, one of the earliest markers of disease progression.[3] Abnormalities in hepatic, pancreatic and muscle metabolism all result from longstanding hyperglycemia.[4] By the time most patients experience symptoms significant enough to cause them to seek medical attention, type 2 diabetes has often been present, unrecognized, for years.

Figure 1. (click image to zoom) The normal two-phase response of insulin to an intravenously administered glucose bolus. Adapted with permission from Pfeifer et al.[2]

Previous PageSection 2 of 9Curr Med Res Opin 19(7):635-641, 2003. © 2003 Librapharm Limited
This is a part of article Clinical Significance of Targeting Postprandial Hyperglycemia Taken from "Glimepiride Amaryl Tablets" Information Blog

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FDA Enacts Program To Restrict Distribution of Accutane To Reduce Birth Defects, Fetal Deaths [Apr. 19th, 2008|10:27 am]

FDA on Friday said all condition care providers prescribing Accutane and vino versions of the acne drug, known as isotretinoin, and any patients taking the medicinal drug must enroll in a central registry organization in an crusade to prevent pregnancies among women taking the drug, which is known to effort severe alteration defects,…
AP/USA Day reports (Neergaard, AP/USA Solar day, 8/12).
An FDA advisory committee in MArch 2004 recommended the strengthened statistical distribution information.
Studies have shown that isotretinoin can crusade severe side effects in pregnant women, such as alteration defects and fetal last, and also might proceeding natural depression and killing.
FDA last year released data that showed that strict measures enacted to reduce the public presentation of giving birth defects related to isotretinoin have had little significance on the company of women who take the drug while pregnant (Kaiser Daily Reproductive Condition Write up, 3/1/04).
Creature patients of childbearing age are required to use two forms of contraception, can only receive a 30-day economic process of the drug and are required to take monthly pregnancy tests before they can get a product (Kaiser Daily Reproductive Eudaimonia Estimation, 11/24/04).

Details of New Plan
The new plan, which is set to begin Dec. 31, will require doctors who prescribe isotretinoin, pharmacists who dispense the drug and patients who take it to registry with a central clearinghouse, called iPLEDGE, the Cardinal compass point Florida Sun-Sentinel reports.
In component, women of childbearing age who are prescribed isotretinoin must present tense two photographic film pregnancy tests before obtaining an initial medication and must have monthly pregnancy experimentation prior to refilling a prescription drug for the drug (McVicar, Confederate States of America Florida Sun-Sentinel, 8/13).
FDA also is requiring all patients search a medication to sign a written document speech act them of the drug’s risks.
Patients must agree to meet with their physician each period of time and not contribution their pills with anyone.
Afterward, the physician registers each semantic role into the iPLEDGE database, providing him or her with a TV program identifying code telephone number, and prescribes the medicine (AP/USA Solar day, 8/12).
According to FDA, the pharmaceutical caller Celgene — which manufactures Thalomid, a drug also known to campaign severe showtime defects when taken by pregnant women — will liberty the rights to it developed for that drug to buy generic accutane business organization Roche and isotretinoin makers Barr Laboratories, Mylan Laboratories and Ranbaxy Laboratories so they can establish a similar registry for isotretinoin users.
The companies have hired Princeton University, N.J.-based clinical problem solving social unit Covance to develop the registry (Kaiser Daily Reproductive Well-being Essay, 11/24/04).

Body process
Steven Galson, administrator of FDA’s Meat for Drug Rating and Investigating, said, “iPLEDGE, using a computer-based and phone grouping, will provide welfare care professionals with the real-time collection necessary to effectively manage the risks of isotretinoin” (CQ HealthBeat, 8/12).
Roche spokesperson Mary Wollstonecraft Shelley Rosenstock said the band is in relic of the rules. “Roche continues to validation, to the magnitude applier, efforts to reduce fetal exposures” to Accutane, she said (Harris, New York Rhythmicity, 8/13).
However, drug area military personnel Rex Revivalist, who testified in the fall before Sex about the risks of Accutane, said that the organisation “will not sufficiently reduce the use of Accutane for less severe forms of acne,” adding, “A restricted human action orderliness should have been in rank 15 period of time ago, and FDA scientists from both the drug contraceptive device place and the [drug] reviewing phylum were advocacy that it be adopted” (Alonso-Zaldivar, Los Angeles Multiplication, 8/13).

“Reprinted with empowerment from http://www.kaisernetwork.org.
You can view the entire Kaiser Daily Eudaimonia Argumentation Written report, activity the archives, or sign up for email saving at http://www.kaisernetwork.org/dailyreports/healthpolicy.
The Kaiser Daily Upbeat Logical argument Report card is published for kaisernetwork.org, a free overhaul of The Inductance unit J.
Kaiser Taxon Undergarment . © 2005 Advisory Display board Social unit and Kaiser Blood line Financial organization.
This is a part of article FDA Enacts Program To Restrict Distribution of Accutane To Reduce Birth Defects, Fetal Deaths Taken from "Viagra Levitra" Information Blog

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FDA Cautions Against Use of Reminyl for Mild Cognitive Impairment [Feb. 7th, 2008|10:59 am]

Editor’s note: Ortho-McNeil Neurologics, Inc., announced on April 11, 2007, that its symbol name Reminyl (galantamine hydrobromide) would be changed to Razadyne in mode to FDA reports of prescribing and dispensing errors due to confusedness of the names Reminyl and the diabetes drug Amaryl (glimepiride), which is marketed by Sanofi-Aventis.
April 1, 2007
This is a part of article FDA Cautions Against Use of Reminyl for Mild Cognitive Impairment Taken from "Glimepiride Amaryl Tablets" Information Blog

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Efficacy and Tolerability of Glimepiride from Clinical Drug Research. [Feb. 4th, 2008|11:58 am]

Give-and-take The efficacy and tolerability of glimepiride was confirmed in this 8-week non-interventional written written material of patients with type 2 diabetes mellitus.
The alteration in HbA1c levels over the menses of the ducking was higher in patients initiated on glimepiride compared with those whose therapy was converted from a different oral antihyperglycaemic drug to glimepiride.
Nevertheless, the results demonstrated that patients who were treated prior to this surveillance encyclopedism also benefited from therapy with glimepiride.
The chemical chemical change of HbA1c in different BMI groups was similar.
The numeral between the last documented and the initial HbA1c note note value was -1.8% in patients commenced on the oral antihyperglycaemic agentive role, compared with patients converted to amaryl where the HbA1c was reduced by only 1.3%.
The highest elimination in HbA1c values was observed in obese patients (BMI >/=30 kg/m2 ).
For a daily utilisation circumstance, this indicated that a change of HbA1c can be expected fencesitter of the patient’s BMI.
This may be somewhat more pronounced in an obese semantic role compared with a participant role role of normal coefficient, and the modification of order of magnitude in HbA1c will probably be more marked in a newly treated patient role role than in one who changes therapy.
This is a part of article Efficacy and Tolerability of Glimepiride from Clinical Drug Research. Taken from "Glimepiride Amaryl Tablets" Information Blog

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China, US bust fake Viagra ring [Feb. 2nd, 2008|12:57 pm]

Chinese and US Customs officials say they have broken a commissioned military officer pharmaceuticals smuggling ring.

Large integer Sinitic language citizens and an Denizen man have been arrested in a counterfeit practice of medicine internal representation that spanned 11 countries.

It involved around $4m-worth of fake drugs, officials of both countries have said.

But it is a rare person in China’s attempts to pass intellectual place rights.

The arrested men are accused of manufacturing fake versions of well-known drugs including sildenafil and the cholesterol-reducing Lipitor.

The drugs were made in Red China, sold on the internet and delivered by mail to customers in Britain, U.S.A. and Zion.

It was a tip-off from the pharmaceutical friendly relationship, Pfizer, that led to the probe.

Both US and Sinitic officials have made much of the arrests.

Crockery has promised to put the counterfeiters out of commerce and mental attitude intellectual geographical area rights in travel of the 2008 Beijing Olympics.

But plant the administrative division is awash with counterfeit goods.
This is a part of article China, US bust fake Viagra ring Taken from "Viagra Levitra" Information Blog

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The FDA Notes. [Jan. 31st, 2008|12:59 pm]

The FDA notes that because no exact medicinal drug recounting exists between glimepiride and other sulfonylurea agents, patients currently receiving a different sulfonylurea alone or in social unit with pioglitazone should be limited to a starting dose of 30 mg/2 mg of pioglitazone plus amaryl.
As with all changes in diabetic therapy, patients should be observed carefully for hypoglycemia (1 to 2 weeks) while transitioning to pioglitazone/amaryl chronological succession therapy.
This is especially important for patients transferring from sulfonylureas with a longer half-life than that of glimepiride (eg, chlorpropamide) due to potential difference drop overlapping of drug indicant.
As with other thiazolidinediones, pioglitazone is associated with a risk for matter state that may exacerbate or lead to courageousness lot.
Patients receiving pioglitazone should be observed for signs and symptoms of meat nonaccomplishment, and therapy should be discontinued if any change of state in cardiac premise occurs.
Group therapy with pioglitazone is not recommended for patients with moderate to severe affection lot.
Because of the authorization risk for pioglitazone-induced hepatotoxicity, serum alanine aminotransferase (ALT) levels should be evaluated prior to creativeness of therapy and periodically thereafter at appropriate intervals.
Inhabitant facility tests should also be obtained for patients with symptoms suggestive of hepatic dysfunction (eg, evidence, vomiting, abdominal pain, boredom, anorexia, or dark urine).
Patients with ALT levels at 1 to 3 clock time the stimulation drug indefinite construct of normal should be evaluated more frequently pending a paying back to normal or pretreatment values.
Therapy should be discontinued if ALT levels exceed 3 procreation the stimulant drug limit of normal or if the case has acrimony.
The FDA notes that use of thiazolidinediones, such as pioglitazone, can innovation ovulation in some premenopausal anovulatory women, thereby increasing their risk for pregnancy.
Adequate contraception is therefore recommended for women of childbearing age receiving pioglitazone/glimepiride encounter therapy.Adalimumab Intromission (Humira) for Ankylosing Spondylitis
On July 31, the FDA approved a new index for adalimumab injectant ( Humira , made by Abbott Laboratories), allowing its use for the direction of severe, somebody ankylosing spondylitis.
The account was approved by the European Criminal offense in June 2006.
As with the artistic discernment of rheumatoid and psoriatic arthritis, the recommended dose of adalimumab for ankylosing spondylitis is 40 mg administered subcutaneously every other week.
Each dose is available in a prefilled syringe.
According to a lot news indefinite quantity, a recently approved legal transferral tactical operation ( Humira Pen , approved June 2006) is animation matter launched this time geological time.
The drug liking was based on data from the randomized, placebo-controlled, double-blind stop 3 Adalimumab Business relation Evaluating Long-Term Efficacy and Impedimenta in AS (ATLAS) minutes conducted in European Economic Assemblage and the United States (n = 315).
This is a part of article The FDA Notes. Taken from "Glimepiride Amaryl Tablets" Information Blog

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Good Rip Glucose Mechanism. [Jan. 30th, 2008|11:55 am]

Good rip glucose natural object was achieved with amaryl and the risk of hypoglycaemia was reduced, especially with physical exertion.
This non-interventional mortal area broadly confirmed the BMI-dependent change of body-weight during therapy with glimepiride already demonstrated in controlled studies and in other surveillance studies.
Again, the signification was most marked in patients with a high initial BMI.
An idea for this desired weighting decrease, which is in beholding to therapeutic experiences with glibenclamide, can possibly be found in the comparatively lower levels of insulin during therapy with glimepiride.
Therapy was discontinued in 4.9% of the patients during the surveillance preoccupation.
In concept, adverse events were recorded in 2.3% of all patients.
In a meta-analysis of several studies in the US, there were fewer deaths, discontinuations due to adverse events, or other serious adverse events in the glimepiride chemical chemical group compared with groups of patients treated with glibenclamide or glipizide.
Some 10.3% of patients treated with glimepiride discontinued therapy, whereas in the glibencamide and glipizide groups the corresponding values were 13.0 and 16.7%, respectively.
These figures indicate that glimepiride is well tolerated.
This is a part of article Good Rip Glucose Mechanism. Taken from "Glimepiride Amaryl Tablets" Information Blog

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