Prescrire international
-
Prescrire international · Aug 2000
Indications and choice of antihypertensive drugs (cont'd): British recommendations.
(1) In the absence of other cardiovascular risk factors, antihypertensive monotherapy should be started in patients with a systolic blood pressure of at least 160 mm Hg or a diastolic pressure of at least 100 mm Hg at repeated measurements.
-
Prescrire international · Jun 2000
Lidocaine + prilocaine before 3 months of age: new indication. Correct use is crucial.
(1) The lidocaine + prilocaine combination, as a cream or adhesive dressings, is now approved for anaesthesia of healthy skin in children of 0 to 3 months, an age range in which it used to be contraindicated. (2) The clinical file on the lidocaine + prilocaine combination in this age range is of acceptable methodological quality. (3) For circumcision, two trials showed that the lidocaine + prilocaine cream was more effective than a placebo cream in preventing pain. Two other trials showed that the lidocaine + prilocaine cream was less effective than penile block or local anaesthetic injection in newborns. (4) During heel blood sampling in newborns, the two available comparative trials showed no analgesic efficacy of the lidocaine + prilocaine combination. However, heel blood sampling is an unnecessary procedure. (5) The two comparative trials involving venepuncture in newborns showed, at best, a moderate analgesic effect of the lidocaine + prilocaine combination. (6) Cases of symptomatic methaemoglobinaemia have occurred when recommended conditions of use are not observed.
-
Prescrire international · Aug 1999
Comparative StudyCodeine for child pain: new preparation. Helpful in some cases.
(1) This codeine-based syrup is indicated for the treatment of pain in children. It is the first step 2 analgesic (WHO classification) to become available in France for oral treatment of children. (2) Efficacy and the optimal dose regimen are based mainly on lengthy experience with codeine in other countries. Only a few small trials on acute pain are available. (3) The safety profile is that of all opiates: adverse effects comprise mainly constipation, nausea and vomiting. (4) Accidental ingestion by a young child can lead to severe poisoning.
-
Prescrire international · Aug 1999
Comparative StudyOctreotide and bleeding oesophageal varices: new indication. Nothing new.
(1) Octreotide, a synthetic somatostatin analogue, is now also indicated for emergency treatment of ruptured oesophageal varices pending endoscopic treatment. (2) The assessment file in this indication is limited. (3) The two available comparative trials show no difference in efficacy compared with terlipressin, but their statistical power was low. Octreotide has not been compared with somatostatin, the efficacy of which is not clearly established either. (4) A placebo-controlled trial, published only as an abstract, showed no specific activity of octreotide on bleeding oesophageal varices. (5) There are few reports of adverse effects with octreotide. There is nothing to suggest that its adverse effects differ from those of somatostatin, when the drug is used in patients who cannot tolerate terlipressin. Octreotide is no easier to administer than somatostatin or terlipressin.
-
Prescrire international · Jun 1999
Sales representatives: a damning report by Prescrire reps monitoring network.
(1) Despite increasingly numerous regulatory constraints, as well as international reports and recommendations, medical representatives in France continue to mislead prescribers knowingly. Data collected over the last eight years by Prescrire's reps monitoring network speak for themselves.