Drug and Therapeutics Bulletin current issue

Only in England

2009-06-30

{blacktriangledown}Melatonin for primary insomnia?

2009-06-30

Melatonin, a hormone produced by the pineal gland, has a key role in regulating circadian rhythms, most importantly, the sleep-wake cycle.1 Melatonin's action has led to its being tried as a treatment for a wide range of sleep disorders, such as jet lag, primary insomnia, sleep-wake cycle disruption and sleep problems in children with neuro-developmental disorders.2^–6 Until recently, it had not been licensed in the UK for any indication. Prolonged-release melatonin (Circadin – Lundbeck) has now been licensed as a treatment for primary insomnia. Here we consider whether this product has a place in the management of people with this condition.

Which approach for first trimester miscarriage?

2009-06-30

Around 15% of all known pregnancies miscarry during the first trimester.1 Historically, first trimester miscarriage was managed surgically to remove all retained products of conception, with the aim of minimising the likelihood of blood loss and infection from retained tissue.2,3 Nowadays, medical management (use of drugs such as mifepristone and misoprostol) and expectant management (i.e. allowing the miscarriage to conclude naturally) have become alternatives to a surgical procedure for managing women with early miscarriage. Here, we review the evidence on these three methods to assess the benefits and disadvantages of each.

What are excipients doing in medicinal products?

2009-06-30

Medicinal products contain not only active drugs but also other ingredients included for a variety of purposes and collectively known as excipients (from the Latin word excipere, meaning ‘to take out or receive’).1,2 Prescribers may wrongly overlook or dismiss excipients on the assumption that these are inactive. In reality, such substances are not always inert and may have risks.3 Here we consider why excipients are present in medicines, their potential unwanted effects, how they are regulated and where to find out more about them.