Drug and Therapeutics Bulletin recent issues

Uncommon knowledge

Tue, 03 Nov 2009 14:01:19 PST

Aspirin for primary prevention of cardiovascular disease?

Tue, 03 Nov 2009 14:01:19 PST

Cardiovascular disease (CVD) is a leading cause of mortality.1 For example, in 2000, it accounted directly for around 2 million deaths in the European Union.2 Worldwide, many people take aspirin daily in the belief that doing so helps to prevent CVD. This approach is established for the secondary prevention of recurrent vascular events.1,3,4,5 However, there has been some uncertainty about the place of aspirin for the primary prevention of cardiovascular events.6 In particular, there have been doubts about whether any benefits of aspirin in people with no history of CVD outweigh the risks (e.g. the fact that long-term low-dose aspirin therapy almost doubles the likelihood of gastrointestinal haemorrhage).7,8 Here we consider the place of low-dose aspirin in primary prevention of CVD.

Over-the-counter weight loss with orlistat?

Tue, 03 Nov 2009 14:01:19 PST

Orlistat first became available (as 120mg capsules [Xenical]) around 10 years ago as a prescription-only treatment for obesity.1 Earlier this year, orlistat 60mg capsules (alli – GlaxoSmithKline Consumer Healthcare) became available for sale without a prescription to the public in the European Union. Orlistat 60mg is available in the UK as a Pharmacy (P) medicine and so can be purchased over-the-counter (OTC) from pharmacies. OTC orlistat is promoted as a new weight loss aid, "boosting weight loss by 50%" when added to a reduced calorie, lower-fat diet. Here we review the place of OTC orlistat in tackling obesity.

Management of seasonal affective disorder

Tue, 03 Nov 2009 14:01:19 PST

Low mood associated with a certain season (usually winter) is very common. For example, in the UK, up to 6% of adults have "recurrent major depressive episodes with seasonal pattern", commonly known as seasonal affective disorder (SAD).1 2 3 People with SAD consult in primary care more often than age- and gender-matched control groups; patients also receive more prescriptions and are referred more often to secondary care.4 Around 6–35% of patients require hospitalisation for SAD at some point.5 Here we discuss the management of adults with SAD, and in particular light therapy.

Generically speaking

Tue, 06 Oct 2009 14:01:16 PDT

It's best to use the generic name when referring to a medicine. This reduces the likelihood of accidental double prescribing or purchase of a drug, particularly if it has more than one brand name. Prescribing by generic name is also generally cheaper and avoids confusion because the name is internationally recognised. Nevertheless, brand names enjoy undue prominence, even allowing for the clinical situations where it is important to prescribe by brand rather than generic name.

Does BNP testing aid diagnosis of heart failure?

Tue, 06 Oct 2009 14:01:16 PDT

Heart failure is common, causes major disability and often shortens life. Two UK guidelines advocate the measurement of plasma concentrations of B-type natriuretic peptide (BNP) in diagnosis of chronic heart failure, either in combination with, or as an alternative to, an ECG.1,2 Here we review the evidence for BNP testing in the diagnosis of chronic heart failure, and discuss the implications in terms of availability of the test.

Imiquimod for superficial and in situ skin malignancy

Tue, 06 Oct 2009 14:01:16 PDT

Imiquimod, an immune response modifier, is marketed as Aldara 5% cream (Meda) and licensed for treating adults with small superficial basal cell carcinomas (BCCs).1 Numerous uses outside the licensed indications (i.e. ‘off-label’) have been proposed and practised, including as treatment for pre-cancerous conditions such as Bowen's disease (squamous cell carcinoma in situ) and lentigo maligna (an in situ precursor of melanoma).2,3 Here we review the use of imiquimod for small superficial primary BCC in adults, Bowen's disease and lentigo maligna.

Anticoagulation with {blacktriangledown}dabigatran or{blacktriangledown}rivaroxaban

Tue, 06 Oct 2009 14:01:16 PDT

Anticoagulants such as low molecular weight heparins (LMWH; e.g. enoxaparin) and fondaparinux are cost-effective measures for reducing the likelihood of venous thromboembolism (VTE) in patients undergoing surgery.1 Dabigatran etexilate (Pradaxa-Boehringer Ingelheim)2 and rivaroxaban (Xarelto – Bayer) are fixed-dose oral anticoagulants licensed in the European Union (EU) for the prevention of VTE in adults who have undergone or are undergoing elective replacement of the hip or knee joints.2,3 Here, we consider their place for these indications.

{blacktriangledown}Tamiflu - the wrong message?

Fri, 04 Sep 2009 04:18:07 PDT

Self-monitoring for patients on warfarin?

Fri, 04 Sep 2009 04:18:08 PDT

One estimate suggests that at least 1 million people in the UK are on the anticoagulant warfarin.1 This number could increase as more people are treated with the drug for atrial fibrillation and as the elderly population increases.1 Careful control of anticoagulation is essential with warfarin therapy and, traditionally, patients on the drug have had to travel to a clinic to have their blood coagulation time tested. However, the availability of portable self-testing machines makes it possible for some patients to monitor their blood coagulation time at home. Here we examine the evidence on the efficacy and safety of such self-monitoring and consider which patients it most suits and whether more widespread use of the approach is justified.

Non-drug management of chronic low back pain

Fri, 04 Sep 2009 04:18:08 PDT

Estimates suggest that, at any one time, 12–33% of the population have back pain.1 About 5% of a GP's workload involves consultations for the condition,2,3 and around 32% of patients who first present with back pain consult again within 3 months.3 Also, most will still have some pain or disability 1 year after consultation.3 Indeed, patients who have been off work with chronic back pain for 1–2 years are unlikely to return to any form of work in the foreseeable future, whatever treatment they receive.4 Here we discuss the place of non-drug management for patients with the condition.

Correction: how to misinform patients

Fri, 04 Sep 2009 04:18:08 PDT

How to misinform patients

Tue, 04 Aug 2009 14:01:10 PDT

Management of carpal tunnel syndrome

Tue, 04 Aug 2009 14:01:10 PDT

Estimates suggest that around 1 in 10 people develop carpal tunnel syndrome at some point.1 The condition comprises potentially disabling sensory and/or motor symptoms in the hand, caused by compression of the median nerve, and carries considerable implications for employment and healthcare costs.2 Current standard treatment options are splinting, local corticosteroid injections and surgery, and there are a range of other suggested treatments. Here we review how best to manage patients with carpal tunnel syndrome.

So, what exactly is a cytokine?

Tue, 04 Aug 2009 14:01:10 PDT

Discussions about various physiological and pathological processescommonly debate the role of mediators known as cytokines. Also, several drugsare analogues of cytokines or are aimed at blocking the actions of specificcytokines to modify diseases processes.1234So, increasingly, healthcare professionals need to have a working knowledgeof cytokines. With this in mind, here, we briefly describe the types and actionsof cytokines, some aspects of their role in certain diseases and the use ofdrugs to augment or block their action.

{blacktriangledown}Ezetimibe - an update

Tue, 04 Aug 2009 14:01:10 PDT

Ezetimibe (Ezetrol – MSD-Schering Plough) is a lipid-lowering drug that reduces plasma concentrations of low-density lipoprotein (LDL) cholesterol and total cholesterol when used alone or in combination with a statin.1 In 2004, we could find no evidence on the effects of ezetimibe on cardiovascular morbidity and mortality and concluded that it should not replace a statin in the routine management of patients at increased risk of developing complications of atherosclerotic disease.1 Since then, a fixed-dose combination product, containing simvastatin and ezetimibe (Inegy – MSD-Schering Plough), has been launched in the UK, and new evidence on the safety and efficacy of ezetimibe has been published. Here we reconsider ezetimibe in light of the new product and data.

Understanding statistical terms: 5 - systematic reviews and meta-analyses

Tue, 04 Aug 2009 14:01:10 PDT

An increasing number of statistical terms appear in journal articles and it can be difficult to keep abreast of these. With this in mind, DTB is producing a series of short explanatory articles covering various terms and their uses.1234 This, the fifth article in the series, will focus on terms related to systematic reviews and meta-analyses.