Drug Topics - April 14, 2008 - (Page 18)

18 DRUG TOPICS APRIL 14, 2008 www.drugtopics.com Rx Care NSAIDs not recommended for long-term use in osteoarthritis Jillene Magill-Lewis, R.Ph. onsteroidal anti-inflammatory drugs (NSAIDs) have long been used to reduce pain and inflammation caused by osteoarthritis (OA). Until recently, these drugs were prescribed in fairly high doses and often for years, according to Steven B. Abramson, M.D., director of rheumatology and professor of medicine at New York University School of Medicine. Now, the pendulum has swung the other direction, Abramson said. Prescribers are now more reluctant to prescribe NSAIDs because of the recent evidence of cardiovascular risks associated with the drugs, in addition to the well-documented gastrointestinal risks. The pendulum is In 2006, the Osteoarthritis Research Society swinging against International (OARSI) formed an international the use of NSAIDs for OA, says Stecommittee to review all guidelines and evidence ven Abramson. available on OA. The end result is a new set of 25, evidence-based recommendations for the treatment of hip and knee OA. Based on the evidence of potentially serious adverse reactions to NSAIDs, the committee has advised against the long-term use of NSAIDs to treat OA. Although the OARSI committee decided that longterm NSAID use is not appropriate for OA, the committee also determined that NSAIDs can be effective, short-term pain relievers for the disease. Abramson, who is also president of OARSI, advised using the lowest effective dose of NSAIDs to treat OA symptoms. Once patients respond to treatment, they should be weaned off the medications. “Try and avoid long-term treatment if possible,” he said. N chondroitin, weak opioids, narcotic analgesics, topical capsaicin, and topical NSAIDs. Also included are intraarticular injections of corticosteroids and hyaluronate. They are recommended on a temporary basis according to severity of symptoms. The guidelines have been well-received by arthritis specialists, according to Abramson. The challenge now is to disseminate the information. This is one area where pharmacists can play a huge role. Abramson said pharmacists need to counsel patients that multiple therapies may be needed to treat their OA. Pharmacists can advise patients on proper OTC use and help them select braces and orthotics. Abramson also said that although NSAID use is risky, patients should not be denied prescription NSAIDs if OTC remedies are ineffective. Pharmacists should also be on the alert for patients with OA who present prescriptions for opioids. Although these drugs can be of use in OA, Abramson said patients should be evaluated by a rheumatologist if they are to the point of needing opioids. A good specialist will use therapies in combination and in proper order. Incorporating lifestyle changes “One of the biggest challenges for pharmacists is to incorporate lifestyle modification into counseling points for patients with OA,” said Kristen Binaso, R.Ph., a spokesperson for the American Pharmacists Association and a community pharmacist. Often, pharmacists focus on medication, but “we really need to stress these nonpharmacological changes,” she said. Advising patients about proper footwear, for example, is an important, nonpharmacologic component in treating OA. It’s also important to explain that acetaminophen and NSAIDs work differently, Binaso said. Monitoring for adverse reactions and drug interactions is another invaluable pharmacy service, especially since OA patients are likely to take both prescription and OTC medications. Some patients may be reluctant to try non-drug methods or to pay for doctor visits and prescriptions when they can buy OTC remedies. Pharmacists can help guide them in the right direction. As Binaso put it, “I think it’s a matter of helping patients set priorities.” The complete guidelines can be viewed on the OARSI Web site: www.oarsi.org. THE AUTHOR is a writer based in the Seattle area. Long-term treatment options Pharmacists might wonder what the long-term treatment options for OA are, if the NSAIDs are now out of favor. According to the new guidelines, no single drug or therapy is crowned as the ideal treatment for OA. Instead, a multi-modal approach chosen from a menu of options should be tailored for each individual patient. The OA menu is a list of treatments that the committee agreed are effective for use in the disease. The treatments are grouped in categories of pharmacologic, nonpharmacologic, and surgical therapies. Included in the pharmacologic category of the guidelines are NSAIDs, acetaminophen, glucosamine, http://www.drugtopics.com http://www.oarsi.org

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Drug Topics - March 14, 2008 Contents Latebreakers Letters: Students Need Grounding in Chemistry Pharmacy Directors Wary of Heparin Shortages Some E-prescribing Standards are Ready to Go, Others are Not News Briefs Nanotechnology: Big Stakes in a Small World Pay for Performance is Coming to Pharmacy Patient Safety Organizations Still Very Much in Planning Stage Reconciling Medications in Specialty Patients Poses More Challenges Pharmacy Outsourcing Still Much in Use by Hospitals Studied Extensively, New Drug-Eluting Stent Said to be Very Safe Prevention is Key in Treating C. Difficile Infections E-prescribing Grows in Massachusetts, but Other States Lag Behind Active Metabolite Gives New Life to Antidepressant NSAIDS not Recommended for Long-term Use in Osteoarthritis This Time R.Ph.s and States Are Ready for Tamper-Resistant Rx Pads Cardinal Caught Between DEA and Pharmacies over Diversion Control Medicating Kids: Still More Questions than Answers Schnucks Pharmacy: Drug Topics' Chain of the Year Panel Will Ask for a System for R.Ph. Practice Across State Lines FDA Safety Page: How to use Fentora Safely The Shining OTC/HBC Stars of 2007 Take a Look at These OTCs for Eye Health Technology Update: Google Offers a Sneak Peak at its Electronic Records Initiative Recent Advancements in HIV/AIDS Treatment New Products Advertisers Index Classified Viewpoint: Are State Boards of Pharmacy Abusing Their Power?

Drug Topics - April 14, 2008

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