Prescrire international
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Prescrire international · Aug 2001
Scopolamine: new preparations. Reference treatment for death rattle.
(1) The reference symptomatic drug treatment of death rattle is the use of atropinic agents such as scopolamine or atropine. (2) Marketing authorisation has now been granted in France for scopolamine in this indication, both for a subcutaneous preparation and a transdermal patch. (3) The clinical file on subcutaneous scopolamine delivery mainly comprises non comparative data on 200 patients studied prospectively and 196 patients studied retrospectively. (4) The assessment of transdermal scopolamine patches is limited to a few published cases. (5) Available data show the efficacy of scopolamine, when administered after aspiration of the back of the throat. (6) The main adverse effects are neuropsychological (excitation, hallucinations, delirium). (7) In practice, injectable scopolamine is the reference drug for symptomatic treatment of death rattle.
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Prescrire international · Aug 2001
Exemestane: new preparation. No tangible advance in metastatic breast cancer after tamoxifen failure.
(1) The reference second-line hormone treatment for breast cancer in postmenopausal women, after failure of anti-oestrogen therapy, is an aromatase inhibitor such as letrozole. (2) The clinical assessment file on exemestane, a new aromatase inhibitor licensed for this indication, contains no data from clinical trials versus letrozole or anastrozole, the other oral aromatase inhibitors. Data from non comparative trials fail to show whether cross-resistance between aromatase inhibitors exists. (3) In a double-blind trial involving 769 patients in whom tamoxifen had failed, the antitumour effect of exemestane appeared to be equivalent to that of the progestagen megestrol. (4) This trial showed that the adverse effect profile of exemestane was similar to that of other aromatase inhibitors, with mainly vasomotor flushes, nausea, fatigue and sweating. (5) In practice, the arrival of exemestane changes nothing in the hormone therapy of breast cancer in postmenopausal women, which should consist of tamoxifen (an anti-oestrogen) first; followed by the aromatase inhibitor letrozole if tamoxifen fails.
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(1) Cases of ischaemic colitis due to pseudoephedrine have been reported. (2) The presence of pseudoephedrine in many non prescription drugs must not be overlooked.