Prescrire international
-
Prescrire international · Feb 2013
ReviewInjectable paracetamol in children: yet more cases of 10-fold overdose.
Intravenous paracetamol injection is associated with a risk of 10-fold overdose. This is due to confusion between normal dose prescription in milligrams and administration in millilitres of injectable solution (containing 10 mg per ml). ⋯ In practice, injectable paracetamol should only be prescribed when oral administration is not possible. Care must be taken when calculating the dose to be administered, and the calculation must be double checked before the drug is administered.
-
Prescrire international · Feb 2013
ReviewNeoadjuvant trastuzumab for breast cancer. Better to stick with proven treatments.
No documented increase in overall survival with neoadjuvant trastuzumab, given the lack of trials versus chemotherapy in combination with adjuvant trastuzumab.
-
Dabigatran is an oral anticoagulant that inhibits thrombin but not vitamin K. In mid-2012, there was no commercial test to monitor its anticoagulant effect, nor an antidote. In mid-November 2011, the European pharmacovigilance database contained 256 reports of haemorrhagic deaths attributed to dabigatran. ⋯ A dabigatran dose below 220 mg per day does not protect patients from the risk of haemorrhage. In practice, dabigatran should be reserved for patients with a high risk of thrombosis in whom the target INR cannot be maintained on antivitamin K therapy alone. The risk of bleeding must be taken into account, renal function must be closely monitored, and patients and their carers must be correctly informed about this risk.
-
Prescrire international · Feb 2013
ReviewFirst-line treatment of metastatic prostate cancer. Androgen suppression for symptomatic disease.
Prostate cancer sometimes metastasizes, especially to bone, which may cause pain, fractures and spinal cord compression. What are the best first-line treatment options for patients with metastatic prostate cancer? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. Suppressing androgen secretion by surgically removing the testicles (orchiectomy) or by administering a gonadorelin agonist relieves the pain associated with bone metastases in about 80% of patients. ⋯ First-line hormonal treatments are initially very effective in relieving symptoms of metastatic prostate cancer. Our analysis of the available data suggests that the best treatment option is androgen suppression with goserelin. Flutamide monotherapy is an alternative for some patients.