Drugs Information Center(DIC)

Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment. Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. Thus in apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. Subscribe to Drugs Information Center by Email

The JUPITER (Justification for the Use of Statins in Primary Prevention Intervention) trial has shown that rosuvastatin reduces the risk of cardiovascular events by 54% in people who do not have high cholesterol level but have raised high sensitive C reactive protein. The trial was scheduled for a follow up of 4 years, but after nearly two years as there was a significant reduction in the primary end point at two years tyhe trial was stopped. The original research article and an editorial was recently published in NEJM. There are two important issues regarding the results of this trial 1. Long term safety of rosuvastatin is not yet established. If we are going to start rosuvastatin for a low risk subject without any clinical disease for primary prevention, he will be taking it for a long period say 20 years. In such case without long term safety being established, it should not be advised. 2. Secondly the patency of rosuvastatin is now held by Astra Zeneca and the drug is very costly n

Vasovist (gadofosveset trisodium) - formerly MS-325 Date of Approval: December 22, 2008 Company: EPIX Pharmaceuticals, Inc. Treatment for: Diagnostic Vasovist (gadofosveset trisodium) is a blood pool magnetic resonance angiography (MRA) agent used to evaluate aortoiliac occlusive disease (AIOD) in adults with known or suspected peripheral vascular disease. ZolpiMist (zolpidem tartrate) Oral Spray Date of Approval: December 22, 2008 Company: NovaDel Pharma, Inc. Treatment for: Insomnia ZolpiMist is an oral spray formulation of zolpidem, the drug contained in Ambien. ZolpiMist is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. Oral Fludarabine (fludarabine phosphate) Tablets Date of Approval: December 19, 2008 Company: Antisoma plc Treatment for: Chronic Lymphocytic Leukemia Oral fludarabine (fludarabine phosphate) is an oral nucleoside analogue approved as a single agent for the treatment of adult patients with B-cell chronic lymp

Therapeutic Class ACE Inhibitor Antihypertensive Mechanism of Action Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, is metabolized to a more potent ramiprilat (active drug). Both prevent the conversion of angiotensin I to angiotensin II, a vasoconstrictor agent, which decreases vasopressor activity and aldosterone secretion . Mechanism of Action - Pharmacokinetics Ramipril (prodrug), Protein binding: about 73% Ramipril (prodrug)-Hepatic; almost completely metabolized Ramipril (prodrug): time to peak concentration, within 1 h Ramiprilat (active drug): greater than 50 h Active metabolite: ramiprilat (active drug) Ramipril (prodrug), Bioavailability: 28% Ramiprilat (active drug), Protein binding: about 56% Ramipril (prodrug), Effect of food: reduces rate of absorption Clinical Advice Patient should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness. Advise patient to rise slowly from a sitting or lying pos

Therapeutic Class ACE Inhibitor/Calcium Channel Blocker Combination Clinical Teaching Patient should avoid activities requiring coordination until drug effects are realized, as drug may cause dizziness. This drug may cause edema, headache, or angioedema (deep swelling around eyes and lips and sometimes hands and feet). Instruct patient to report signs/symptoms of peripheral edema, hypotension, or hepatic dysfunction. Advise patient against sudden discontinuation of drug, as this may cause rebound hypertension. Patient should avoid use of potassium-containing supplements or salt substitutes unless approved by healthcare professional. Dosing - Adult Hypertension, Second-line therapy: initial, amlodipine 2.5 mg/benazepril 10 mg ORALLY once daily; may titrate dose up to amlodipine 10 mg/benazepril 40 mg ORALLY once daily, based on clinical response Dosing - Dose Adjustment renal impairment: NOT recommended in patients with severe renal impairment (creatinine clearance less than 30 mL/mi

Our most complex patients are at highest risk for Drug-Drug Interactions. Polypharmacy, narrow therapeutic range of the medication, decreased hepatic and/or renal function of the patient each may increase the risk for DDIs. Each may be identified prior to coadministration. One should consider the potential for DDIs at all steps of the drug-delivery process. In a retrospective review of patients admitted to the emergency department, patients taking 3 or more medications or patients who were 50 years or older taking 2 or more medications had a considerable risk for DDIs. Furthermore, an increasing number of medications administered further increased the risk for adverse effects. Patients taking 2 medications had a 13% risk while patients taking 5 medications had a 38% risk for DDIs. Patients taking 7 or more medications had an 82% risk of developing adverse drug interactions. Advanced age is an additional risk factor for DDIs. Aparasu and colleagues found that the risk for DDIs increases

Therapeutic Class 3rd Generation Cephalosporin Antibiotic Clinical Teaching Advise patient to report severe diarrhea and consult healthcare professional prior to taking anti-diarrhea medicine. Other superinfection signs/symptoms should be reported as well. Dosing - Adult Acute otitis media: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day Bacterial endocarditis; Prophylaxis: (high-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures) 1 g IV or IM 30 to 60 minutes prior to procedure. Bacterial musculoskeletal infection: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day Chancroid: 250 mg IM as a single dose Epididymitis: 250 mg IM as a single dose plus doxycycline 100 mg ORALLY twice a day for 10 days Gonorrhea: uncomplicated, 125 mg to 250 mg IM as a single dose Gonorrhea: conjunctivitis, 1 g IM as a single dose Gonorrhea: disseminated, 1 g IV/IM every 24 hr for 24-48 hr after impro

Therapeutic Class 3rd Generation Cephalosporin Antibiotic Clinical Teaching This drug may cause abdominal pain or nausea. Instruct patient to report signs/symptoms serum-sickness-like reactions (rash, urticaria, arthralgia, fever, malaise, enlarged lymph nodes). Advise patient to report severe diarrhea and consult healthcare professional prior to taking anti-diarrhea medicine. Other superinfection signs/symptoms should be reported as well. Dosing - Adult Acute infective exacerbation of chronic obstructive pulmonary disease: 400 mg ORALLY once a day or divided twice a day; depending on type and severity of infection Bronchitis, acute: 400 mg ORALLY once a day or divided twice a day; depending on type and severity of infection Gonorrhea: uncomplicated, 400 mg ORALLY as one-time dose Gonorrhea: disseminated (after parenteral therapy), 400 mg ORALLY twice a day to complete at least one week of therapy Otitis media: 400 mg ORALLY once a day or divided twice a day, depending on type and seve

Advise patient it is unsafe to take more than 4 grams of acetaminophen in a 24-hour period. Instruct patient that many non-prescription combination products may contain acetaminophen. Instruct patient to report signs/symptoms of gastrointestinal hemorrhage, hepatotoxicity, or nephrotoxicity. Patient should take with a full glass of water. Patient should not drink alcohol while taking this drug. Advise patients who drink more than 3 alcoholic drinks a day to consult a healthcare professional prior to taking acetaminophen. Dosing - Adult Dysmenorrhea: 650 to 1000 mg ORALLY every 4 h as needed, maximum 4 g/day Dysmenorrhea: 650 mg RECTALLY every 4 to 6 h; maximum 6 suppositories/24 h Fever: 650 to 1000 mg ORALLY every 4 h as needed, maximum 4 g/day Fever: 650 mg RECTALLY every 4 to 6 h; maximum 6 suppositories/24 h Headache: 650 to 1000 mg ORALLY every 4 h as needed, maximum 4 g/day Headache: 650 mg RECTALLY every 4 to 6 h; maximum 6 suppositories/24 h Pain (Mild to Moderate): 650 to 1000

Ranexa is an anti-anginal medication. It works by improving blood flow to help the heart work more efficiently. Ranexa is used to chronic treat angina (chronic chest pain) when other medications have not helped the condition. It should be used in combination with another medicine (eg, amlodipine, beta-blockers, nitrates). You should not take Ranexa if you have liver disease, hypokalemia (low levels of potassium in your blood), or a personal or family history of "Long QT syndrome." Ranexa should not be taken together with certain medicines to treat heart rhythm disorders, malaria, infections, mental illness, pain, cancer, or stomach disorders. Before you take Ranexa, tell your doctor about all other medications you are using. Ranexa is not for use during an acute (emergency) attack of angina. Continue using any other medicines prescribed by your doctor (such as nitroglycerin) to treat acute angina. Chronic angina is often treated with a combination of different drugs. To best