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HMG CoA reductase inhibitor-induced muscle toxicity: risks, monitoring, and management (PDF)

Although the commonly used HMG CoA reductase inhibitors (statins) are well tolerated and relatively safe, muscle toxicity and rhabdomyolysis can occur with administration and can be severe. This risk is higher with more bioavailable and lipophilic statins. This article summarizes what is known about the etiology of statin-associated muscle toxicity, the risks for each statin, and the current recommendations for monitoring and management.

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Xendos study: Orlistat plus diet prevents, delays diabetes onset in obese patients

Orlistat (Xenical) in combination with diet and lifestyle changes significantly prevents obese patients from developing type 2 diabetes, say researchers involved in this 4-year study presented at the 9th International Congress on Obesity, Sao Paulo, Brazil. They add that this is the first time a weight loss drug has been shown to prevent or delay the onset of type 2 diabetes in an at-risk population.

Eplerenone: The first selective aldosterone receptor antagonist for the treatment of hypertension (PDF)

Eplerenone is a selective aldosterone receptor antagonist under FDA review for treatment of hypertension. With a high trough-to-peak ratio, it is suitable for once-daily dosing. It significantly reduces blood pressure in patients with mild to severe hypertension and can be used alone or in combination with other antihypertensives. Although chemically related to spironolactone, eplerenone has a lower binding affinity for androgenic and progestogenic receptors than spironolactone, which may translate into a lower incidence of endocrine-related adverse effects. In addition, eplerenone lowers blood pressure particularly well in patients with low-renin, salt-sensitive hypertension, such as African Americans.

Evidence-based medicine: What it is, why to use it, and how to incorporate it into decision-making (PDF)

Sometimes regarded with suspicion, evidence-based medicine is not just a ploy to reduce costs. Rather, it is the best approach to decision-making in modern medical practice. This internationally recognized authority on evidence-based medicine explains what it is, how to use it to make the best clinical decisions, and how to implement it in practice. Sometimes regarded with suspicion, evidence-based medicine is not just a ploy to reduce costs. Rather, it is the best approach to decision-making in modern medical practice. This internationally recognized authority on evidence-based medicine explains what it is, how to use it to make the best clinical decisions, and how to implement it in practice.

Rethinking approaches to reducing medication errors: An examination of 10 core processes (PDF)

Although many organizations have implemented well-intentioned medication error reduction strategies, the authors of this article argue that most approaches don?t address the underlying foundation upon which many errors occur. In this article, they present 10 core process improvements?from ?genericizing? all drug names throughout the hospital/health system to purchasing all single-dose packaging?that they believe could have a significant impact on patient safety if implemented.

Facts at a Glance (PDF)

Information about Dr. David Shulkin and the Patient Safety Officer Society

Tegaserod: A 5 HT4 agonist for women with constipation-predominant irritable bowel syndrome (PDF)

Tegaserod maleate (Zelnorm) is the first selective partial 5-HT4 agonist approved by FDA for the short-term treatment of irritable bowel syndrome (IBS) in women whose primary bowel symptom is constipation. To help you prepare for P & T Committee review, this article presents tegaserod?s chemistry and pharmacology, pharmacokinetics, clinical trial results, adverse effects profile, dosing information, cost, and the author?s opinion on its place in therapy.

Anticoagulant bridging: Prosthetic heart valves, labeling changes, and limiting issues of liability

With enoxaparin?s recent labeling change regarding its use in patients with prosthetic valves, clinicians may have several questions about appropriate anticoagulant selection. Specifically, what evidence prompted the labeling change, which patients are affected, what are the options and limitations for bridging patients, what?s the evidence supporting the role of low molecular weight heparins (LMWHs) in bridge therapy, and how can liability be limited should clinicians choose to use LMWH therapy? The authors of this commentary offer their insight on these issues.

Senate backs legislation easing access to generic drugs and to cheaper imports

Instead of adopting a Medicare pharmacy benefit plan in July, the Senate approved legislation designed to make pharmaceuticals less expensive for all consumers. The House and Senate, however, remain far from agreement on any final legislation involving pharmaceutical coverage and regulation, and time is running out for action before the Congressional elections this November.

Voriconazole: A novel azole antifungal agent (PDF)

In late May, voriconazole (Vfend) received approval for the treatment of invasive aspergillosis and as salvage therapy for treatment of Scedosporium apiospermum and Fusarium infections. In addition to these infections, voriconazole has excellent invitro activity against both Candida and Aspergillus species, including good activity against fluconazole- and itraconazole-resistant species. This Focus article reviews the antifungal's pharmacology, pharmacokinetics, efficacy in clinical trials, safety, dosing, price, and place in therapy.

Understanding the costs and treatments of alcohol abuse and dependence (PDF)

Effective decision-making in benefit management requires an understanding of the economic burden of an illness - in this case, the economic burden and treatment of alcoholism. This article provides an understanding of the true costs of the disease, what has been found to be effective in its treatment, and what treatments may lessen the economic burden of the disease.

The guideline development process: One organization's experience with a guideline for stable COPD (PDF)

Finding optional ways to manage patients with chronic obstructive pulmonary disease (COPD) - the fourth leading cause of death in the US became a priority for this large mid-western collaborative of health care organizations. This this end, a guideline was developed to help clinicians identify, evaluate and manage COPD. This article provides an overview of the guideline development process and implementation approach, key guideline components, and the step-by-step pharmacologic treatment strategy.

Did naproxen's cardioprotective effect skew safety data on rofecoxib?

Three case-controlled studies published in the Archives of Internal Medicineshow naproxen sodium has cardioprotective effects that other NSAIDs don't.An accompanying editorial says that no evidence indicates that the COX-2inhibitor rofecoxib increases (or decreases) MI risk. It simply fell victimto being compared with the only NSAID (ie, naproxen) shown to have a cardioprotectivebenefit. (None of these new studies directly compared non-naproxen NSAIDswith COX-2 inhibitors.)
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