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Clinical Briefs
Aciphex vs. Aricept
Errors
Similar packaging, labeling, color scheme and bottle size make the
proton-pump inhibitor Aciphex (rabeprazole) by Eisai; Janssen and
the dementia drug Aricept (donepezil) by Eisai; Pfizer hard to
distinguish. Avoid storing these similar appearing medications next to
each other to prevent this unsafe situation from becoming a dispensing
error.
Pharmacy Today, Feb 2001
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Paxil vs.
Risperdal Drug Interaction
There is new evidence of a significant drug interaction between Paxil
(paroxetine) and Risperdal (risperidone). Recent studies show that
adding paroxetine to the therapy of patients receiving risperidone
resulted in three- to nine-fold increases in risperidone steady-state
plasma concentrations and the development of extrapyramidal symptoms
(EPS). Paroxetine is a potent inhibitor of CYP2D6, the cytochrome P450
enzyme that primarily metabolizes risperidone. SSRIs have the potential
themselves to cause EPS, creating an additive pharmacodynamic effect. You
may wish to recommend monitoring for side effects, lowering the dose or
using an antidepressant unlikely to inhibit this enzyme (venlafaxine,
bupropion, nefazodone or mirtazapine).
Pharmacist’s Letter, Vol 17, No 12, Dec
2001
Zyprexa May Improve TD
The atypical antipsychotic Zyprexa (olanzapine) may prove to be a
safe and effective option for patients with schizophrenia who have
developed Tardive Dyskinesia (TD). The effect of olanzapine on ninety-five
schizophrenic patients with pre-existing, moderate to severe TD resulting
from long-term treatment with antipsychotics other than clozapine or
olanzapine, was evaluated in a double-blind trial. The trial included up
to two medication reductions to determine if olanzapine was improving TD
or simply masking its effects. Nearly 70% of subjects achieved significant
reduction in mean AIMS (Abnormal Involuntary Movement Scale) scores with
olanzapine doses of 5-20mg per day. Improvement in TD was sustained over
eight months, with greater than 50% improving in eight weeks. On average,
TD did not worsen during dose reductions of 75%. The most common
treatment-emergent side effect was somnolence.
Eli Lilly and Company, October 12, 2001
Topamax Ocular Syndrome
Ortho-McNeil issued a Dear Healthcare Professional Letter to notify
practitioners about an ocular syndrome that has occurred in twenty-three
patients receiving the anticonvulsant Topamax (topiramate). The
syndrome is characterized by acute myopia and secondary angle closure
glaucoma in adults, as well as pediatric patients. Symptoms have typically
occurred within the first month of therapy and include an acute onset of
decreased visual acuity and/or ocular pain. If patients develop this
syndrome, the primary treatment to reverse symptoms is discontinuation of
topiramate as rapidly as possible, in conjunction with other measures as
directed by the treating physician. Elevated intraocular pressure, if left
untreated, can lead to serious sequelae including permanent vision loss.
Patients taking topiramate should be told to seek immediate medical
attention if they experience blurred vision or periorbital pain.
Ortho-McNeal, Dear Healthcare
Professional Letter, Sept 26, 2001
Administer PPIs Just Before Meals
Proton-pump inhibitors (PPIs) work best if given 15-30 minutes before a
meal. PPIs are formulated with enteric coatings or delayed-release dosage
forms so that they are not broken down by the low pH of the stomach. The
average plasma half-life of the typical PPI is about 2 hours. Once
absorbed from the small intestine, these agents only enter parietal cells
that are actively secreting acid, binding irreversibly and inhibiting the
acid pump for 2-3 days. Pharmacologically speaking, serum drug levels
should be highest when the maximum number of proton pumps are functioning.
According to a recent survey, however, only 12% of patients were taking
their PPIs during the preferred time frame. Incorrect timing of dosage
administration can render these expensive medications worthless. Recommend
giving PPIs 15-30 minutes before a meal and advise physicians to consider
correcting administration times before concluding that patients have
failed therapy.
APhA Drug Info Line, Vol 2, No7, July
2001
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