Expert opinion on drug safety
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Expert Opin Drug Saf · Jan 2006
ReviewWhen science is not enough - a risk/benefit profile of thiomersal-containing vaccines.
Without a preservative, such as thiomersal (known as thimerosal in the US), multi-dose liquid presentations of vaccine are vulnerable to bacteriological contamination that can result in death or serious illness of the recipient. Concerns about levels of mercury exposure from thiomersal-containing vaccines were first raised in the US during 1999 in the context of Hepatitis B vaccine for newborns. Since then, a large body of evidence from animal and epidemiological studies has accumulated on the safety of thiomersal. ⋯ There is a real danger that this controversy may result in the loss to the world of thiomersal as a preservative, simply from popular pressure. In reality, it would be impossible to cease overnight using thiomersal and maintain the supply of vital vaccines. This paper reviews and summarises the data available from published studies on mercury toxicity, and thiomersal in vaccines in particular, that overwhelmingly indicate continued use of thiomersal is safe in those countries where it is most needed.
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Expert Opin Drug Saf · Nov 2005
ReviewThe safety and efficacy of the use of vasopressin in sepsis and septic shock.
Sepsis remains a significant problem and cause of morbidity and mortality in intensive care. Vasopressin infusions are currently used as rescue therapy for the treatment of vasodilatory, catecholamine-resistant septic shock. ⋯ A review of the safety data for vasopressin in this indication is included. Recommendations for the use of vasopressin in septic shock, along with suggestions for the direction of further work in the field are presented.
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Expert Opin Drug Saf · Nov 2005
EditorialInteractions between herbal remedies and antirheumatic drugs.
Many patients with rheumatological conditions use herbal remedies as an adjunct to their conventional antirheumatic medication, often without seeking advice. Herbal remedies are exempt from the usual drug safety requirements and may be a cause of both adverse effects and drug interactions. ⋯ Interactions are likely between herbal remedies with antiplatelet or nephrotoxic effects and NSAIDs, hepatotoxic herbal remedies and disease-modifying antirheumatic medication, and between St. John's Wort and cyclosporin.
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Remifentanil is the newest of the fentanyl family of short-acting phenylpiperidine derivatives to be released into clinical practice. Remifentanil is a pure agonist at the mu opioid receptor with relatively little binding at the kappa, sigma or delta receptors. This is precisely the same profile as the other opioids currently popular in anaesthetic practice (fentanyl, alfentanil, sufentanil) and it offers the same advantages (profound analgesia, sedation, attenuation of the stress response). ⋯ The untoward effects of remifentanil, given by continuous infusion, are well-described in the literature. They are predictable and easily managed by experienced clinicians. This review will concentrate on the adverse effects of remifentanil given by bolus injection, either alone or in the context of a background infusion.
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Expert Opin Drug Saf · Jul 2005
EditorialCounterfeit drugs: defining the problem and finding solutions.
The problem of counterfeit drugs is increasingly becoming a top priority of drug regulatory agencies, licit pharmaceutical manufacturers and healthcare professionals, and is of rising concern among consumers. A review of the current literature reveals that counterfeiting is no longer isolated in developing nations, but is a worldwide pandemic. Although international organisations such as the World Health Organization, have devised specific measures to combat the counterfeit trade, the problem still remains quite daunting. Although the practice of drug counterfeiting is unlikely to ever completely disappear, it may be controlled if governments and all relevant parties combine forces to identify and disrupt the counterfeit chain.