Prescrire international
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Prescrire international · Jun 2011
2010 drug packaging review: identifying problems to prevent errors.
Prescrire's analyses showed that the quality of drug packaging in 2010 still left much to be desired. Potentially dangerous packaging remains a significant problem: unclear labelling is source of medication errors; dosing devices for some psychotropic drugs create a risk of overdose; child-proof caps are often lacking; and too many patient information leaflets are misleading or difficult to understand. Everything that is needed for safe drug packaging is available; it is now up to regulatory agencies and drug companies to act responsibly. In the meantime, health professionals can help their patients by learning to identify the pitfalls of drug packaging and providing safe information to help prevent medication errors.
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Prescrire international · Jun 2011
ReviewAcute heart failure with dyspnoea: initial treatment. Furosemide and trinitrine, despite the lack of a proven survival benefit.
For patients with acute heart failure and dyspnoea due to pulmonary congestion, the risk of death in the short term is high. To determine how best to manage these patients, we reviewed the relevant literature using the standard Prescrire methodology. There are few reliable clinical trial data. ⋯ Treatment is mainly based on loop diuretics, nitrate derivatives (when blood pressure is not too low) and non-invasive ventilation. It should be emphasised that these patients are highly unstable and that there is a narrow margin between beneficial and harmful effects of available treatments. Patients receiving treatment should always be closely monitored.
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Prescrire international · Jun 2011
Comparative StudyDenosumab. Limited efficacy in fracture prevention, too many adverse effects.
The standard drug for postmenopausal osteoporotic women with a high risk of fracture is alendronic acid, used in conjunction with non-drug measures. There are no drugs with demonstrated efficacy on the risk of fracture in castrated men with prostate cancer. Denosumab, a monoclonal antibody that inhibits a cytokine acting mainly on bone cells and lymphocytes, has been authorised in the European Union for use in both these settings. ⋯ In placebo-controlled trials, this monoclonal antibody was associated with a higher incidence of deep-seated infections such as endocarditis, cancer, and skin rash. More data are needed on the risk of pancreatitis, long-term bone disorders (atypical fractures, delayed fracture healing, osteonecrosis of the jaw), hypocalcaemia and cataracts, all of which were reported in clinical trials. In practice, denosumab is not sufficiently effective to outweigh its established and potential risks in postmenopausal osteoporotic women or in castrated men with prostate cancer.
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Lambert-Eaton myasthenic syndrome is a rare neurological syndrome of autoimmune origin. It is usually associated with small-cell lung cancer but may be idiopathic. The main clinical feature is potentially disabling limb muscle weakness. ⋯ Management is generally based on treatment of the underlying malignancy. Immunosuppressants are used in severe disease and in cases not associated with cancer, but they have limited efficacy. Symptomatic treatments are available but their efficacy is poorly documented.