Pharmacy & Therapeutics- August 2008 - (Page 443) NEW DRUGS NEW DRUGS Generic Marinol (Dronabinol) For Nausea and Vomiting Watson Pharmaceuticals, Inc., has announced the launch of the authorized generic version of Solvay’s Marinol CIII capsules in 2.5-, 5-, and 10-mg once-daily dosage strengths. Dronabinol is indicated for treating nausea and vomiting associated with cancer chemotherapy in patients who have not responded adequately to conventional antiemetic treatments. It is also used to treat anorexia associated with weight loss in patients with acquired immunodeficiency syndrome (AIDS). Patients with hypersensitivity to cannabinoids or sesame oil should not use dronabinol, which is also contraindicated for patients taking sedatives, hypnotics, or other psychoactive drugs; and elderly or pregnant patients, nursing mothers, and children. Caution should be used in patients with seizures; cardiac disorders; mania, depression, or schizophrenia; and a history of substance abuse. (Source: Watson, June 30, 2008.) DRUG NEWS or C, or tuberculosis. • Doctors should not prescribe antiTNF agents if patients have a history of heart failure, lymphoma, or multiple sclerosis. (Sources: American College of Rheumatology, www.rheumatology.org; University of Alabama, main.uab.edu/Sites/ MediaRelations/articles/49478, July 23, 2008.) related adverse events continue to be reported. The risk is increased in people older than 60 years of age; in patients taking corticosteroids; and in kidney, heart, and lung-transplant recipients. The warnings do not apply to fluoroquinolones used in eyedrops or ear drops. (Sources: FDA, July 8, 2008.) Updated Guidelines For Rheumatoid Arthritis Combinations of medications and the introduction of new drugs have improved the treatment of rheumatoid arthritis (RA), according to guidelines issued by the American College of Rheumatology (ACR) and coauthored by physicians at the University of Alabama at Birmingham. The new recommendations include the goal of preventing joint damage and disability. The previous set of ACR treatment guidelines was published in 2002. The guidelines focus on a few classes of agents, including disease-modifying anti-rheumatic drugs (DMARDs). Many antiarthritic drugs are designed to stop damaging inflammation, and biologics disrupt the chain of events that lead to inflammation. Newer biologics prevent the production of an immunity protein that plays a role in inflammation; examples include adalimumab (Humira, Abbott), etanercept (Enbrel, Amgen, Wyeth), and infliximab (Remicade, Centocor). Some key recommendations are as follows: • Methotrexate or leflunomide (Arava, Aventis) is recommended for most patients with RA. • Anti-TNF agents can be used in new or early cases of worsening and severe symptoms. • Doctors should not begin or resume methotrexate, leflunomide, or biologics if patients have an active bacterial infection, shingles, hepatitis B Degraded Drugs: A Common Problem Drugs commonly carried in ambulances throughout the U.S. are vulnerable to potentially dangerous degradation, warn researchers from St. John’s Emergency Medical Ser vices, St. John’s Trauma Ser vices, and Missouri State University, all in Springfield, Missouri. Over the course of one month, investigators found statistically significant decreased drug levels in eight of 23 agents (35%) used in emergency medical services. All of the drugs were exposed to cycled thermal extremes that were documented as actual temperature points in ambulances (–6°C and 54°C); the drugs were then assayed each week for the concentration remaining. Lidocaine, diltiazem (Cardizem, Biovail), dopamine, nitroglycerin, ipratropium (Atrovent, Boehringer Ingelheim), succinylcholine, haloperidol (e.g., Haldol, Ortho-McNeil) and naloxone (Narcan, Endo) all had final concentrations of less than 90%, with strong correlations to thermal exposure time. The drugs of greatest concern are those with fairly narrow dosing ranges. (Source: Am J Emerg Med 2008;26: 566–573.) DRUG NEWS Boxed Warning Added For Fluoroquinolones The FDA has requested manufacturers of fluoroquinolone antimicrobial drugs to provide a boxed warning in the labeling about an increased risk of tendinitis and tendon rupture. The medications involved are ciprofloxacin (Cipro, Cipro XR, Bayer; ProQuin XR, Depomed), gemifloxacin (Factive, Oscient), levofloxacin (Levaquin, PriCara), moxifloxacin (Avelox, Bayer), norfloxacin (Noroxin, Merck), and ofloxacin (Floxin, PriCara). Drug companies are also being asked to provide a medication guide for patients about possible side effects. Despite the current warning of tendon rupture in the labeling for the fluoroquinolones, large numbers of tendon- New Law Ensures Pharmacy Access for Medicare Patients The American Pharmacists Association (APhA) has applauded both houses Vol. 33 No. 8 • August 2008 • P&T® 443 http://www.rheumatology.org http://main.uab.edu/Sites/MediaRelations/articles/49478 http://main.uab.edu/Sites/MediaRelations/articles/49478
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