Nonsteroidal anti-inflammatory drugs (NSAIDs) are often coadministered with proton-pump inhibitors (PPIs) to reduce NSAID-induced gastrointestinal (GI) adverse events. This coadministration is generally regarded as safe, and is included in many of the guidelines on NSAID prescription. However, recent evidence indicates that the GI risks associated with NSAIDs can be potentiated when they are combined with PPIs. This review discusses the GI effects and complications of NSAIDs and how PPIs may potentiate these effects, options for prevention of GI side effects, and appropriate use of PPIs in combination with NSAIDs.
Psychiatric and physical conditions often coexist, and there is robust evidence that associates the frequency of depression with single and multiple physical conditions. More than half of patients with depression may have at least one chronic physical condition. Therefore, antidepressants are often used in cotherapy with other medications for the management of both psychiatric and chronic physical illnesses. The risk of drug–drug interactions (DDIs) is augmented by complex polypharmacy regimens and extended periods of treatment required, of which possible outcomes range from tolerability issues to lack of efficacy and serious adverse events. Optimal patient outcomes may be achieved through drug selection with minimal potential for DDIs. Desvenlafaxine is a serotonin–norepinephrine reuptake inhibitor approved for the treatment of adults with major depressive disorder. Pharmacokinetic studies of desvenlafaxine have shown a simple metabolic profile unique among antidepressants. This review examines the DDI profiles of antidepressants, particularly desvenlafaxine, in relation to drugs of different therapeutic areas. The summary and comparison of information available is meant to help clinicians in making informed decisions when using desvenlafaxine in patients with depression and comorbid chronic conditions.
IntroductionCelecoxib is an effective treatment for pain associated with osteoarthritis. There are differences in patient demographics among ethnic groups, with Asian populations typically smaller in body size. As a consequence, there may be a perception that celecoxib is less effective, or has poorer tolerability in Asian patients.MethodsThis analysis compares data from two multicenter, randomized, double-blind, placebo-controlled, active-comparator trials of celecoxib for the treatment of osteoarthritis of the knee: one study in Asian patients and the other in a mixed population comprised mostly of non-Asian patients (from which Asian patients were excluded for this analysis). Each trial was of similar design, with patients randomized 2:2:1 to 6 weeks treatment with celecoxib 200 mg once daily, active comparator (naproxen 500 mg twice daily or ibuprofen 800 mg three times daily), or placebo. The primary efficacy endpoint in each trial was the change from baseline to week 6 in the Patient’s Assessment of Arthritis Pain, as measured on a visual analog scale.ResultsIn total, 329 patients were included in the efficacy analysis, 179 in the Asian study and 150 in the non-Asian study. The Asian population was significantly older and smaller in body size (P < 0.0001). There was no significant difference between the Asian and non-Asian populations in change in pain score (95% confidence interval) at study endpoint with celecoxib [−1.1 (−7.7, 5.5); P = 0.7400] or placebo [−5.2 (−14.8, 4.4); P = 0.2870]. There were also no notable differences in safety outcomes between populations.ConclusionsDue to the smaller size of some Asian patients with OA, physicians may be tempted to decrease the dose of celecoxib below the therapeutic range recognized by regulatory authorities; these data suggest that dose changes are not necessary.FundingPfizer Inc.
The effects of a single 10-mg dose of loratadine on the performance of commercial and military pilots was compared with placebo in this randomized double-blind trial. Performance was evaluated by flight simulator tests carried out before and after pilots received active drug or placebo. Simulators were specificfor the DC-10, Boeing 747, and AT-26 Xavante fighter aircraft; all reproduced the respective conditions of flight. Pilots' performance, rated by observers blinded to the test, wasjudged to be within operating standards. Thejindings were compatible with those of previous studies that found no sedating effects of loratadine that would impact adversely on automobile driving performance. This and other studies reinforce the pharmacokinetic observation that loratadine does not cross the blood-brain barrier, does not cause sedation, and, therefore, does not impair functional ability. These findings strongly suggest that loratadine use is compatible with the
Introdução: Os contactos não presenciais entre médicos de família e pacientes são componente chave da acessibilidade aos cuidados. Objetivos: Determinar a frequência de utilização do telefone e e-mail entre os médicos de família de Matosinhos e os seus pacientes, bem como as atitudes perante este tipo de contactos. Métodos: Estudo transversal sobre um censo aos médicos de família de Matosinhos, por aplicação de questionário anónimo, de autopreenchimento, em papel. Tratamento de dados com estatística descritiva. Resultados: Obtiveram-se 81 questionários preenchidos (taxa de resposta de 90,0%). Todos os médicos de família referem usar o telefone com pacientes, mas 1/3 nunca/raramente usa o e-mail. A maioria considera que o uso do telefone e e-mail com pacientes é uma sobrecarga, que não tem tempo para esses contactos, mas que facilita a gestão da lista/consulta. A maioria considera também que usaria mais o telefone e o e-mail se pudessem fazer registos em tempo real e que usaria mais o telefone se fosse contabilizado no desempenho. Médicos de família com listas maiores trocam mais telefonemas com pacientes. Médicos de família em USF-B usam mais e-mail com pacientes. Os médicos de família que menos usam o e-mail são os que mais consideram que é uma sobrecarga e que o risco do seu uso é superior ao benefício, sendo também os que mais discordam que o e-mail facilita a gestão da lista/consulta e os que mais afirmam que não usariam mais o e-mail se tal fosse contabilizado no desempenho. Conclusão: Todos os médicos de família usam telefone com pacientes, mas expressam várias atitudes negativas. Os médicos de família que mais usam e-mail têm atitudes mais positivas perante essa prática que aqueles que o usam raramente ou não usam. As políticas organizativas devem considerar as atitudes dos médicos de família.
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