Prescrire international
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Prescrire international · Jan 2013
Comparative StudyOxycodone + naloxone: choose morphine and optimal laxative therapy instead.
At high doses of oxycodone, the fixed-dose combination of oxycodone plus naloxone complicates therapeutic management and will likely have lower analgesic efficacy.
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Avoidance of irritants such as tobacco smoke slows the progression of severe chronic obstructive pulmonary disease (COPD). Drugs have only a modest, purely symptomatic effect; a bronchodilator is combined with an inhaled corticosteroid when exacerbations are frequent. Oxygen therapy prolongs survival in very severe disease. ⋯ Roflumilast is metabolised by cytochrome P450 isoenzymes CYP 3A4 and CYP 1A2, creating a high potential for pharmacokinetic interactions. In practice, it is better not to use roflumilast. For patients with severe COPD and repeated exacerbations, the standard treatment remains an inhaled bronchodilator combined with an inhaled corticosteroid, or oxygen therapy in some cases.
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Prescrire international · Dec 2012
Comparative StudyFurosemide in acute decompensated heart failure.
In a comparative clinical trial in 308 patients with acute decompensated heart failure, the relief achieved with intravenous furosemide at a dose equivalent to the daily oral dose patients were receiving prior to the acute episode was very similar to that obtained with higher doses of intravenous furosemide. Increasing the dose of intravenous furosemide did not improve the outcome.
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Prescrire international · Dec 2012
Herpes zoster vaccine. Poorly effective in those who need it most.
The results of a clinical trial suggest that zoster vaccination (Zostavax, Sanofi Pasteur MSD) of 1000 healthy persons aged 60 years or over prevents approximately one case of postherpetic neuralgia each year over the next 3 years. Vaccination is less effective in persons over 70 years of age. The results of another clinical trial suggest that vaccination of 1000 healthy persons aged 50 to 59 years prevents about 5 cases of herpes zoster over the following year. ⋯ In one study, the immune response to the vaccine was lower after simultaneous immunisation with a 23-valent pneumococcal polysaccharide vaccine. This live zoster vaccine is contraindicated in immunocompromised individuals, yet they are at highest risk of severe zoster. In practice, zoster vaccination is not sufficiently effective in the elderly to justify its widespread use.