Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Sep 2003
Review Comparative StudyGranisetron: new insights into its use for the treatment of chemotherapy-induced nausea and vomiting.
Granisetron (Kytril, Roche) is a 5-hydroxytryptamine 3 (5-HT(3))-receptor antagonist indicated for the prevention of nausea and/or vomiting associated with initial and repeat courses of emetogenic chemotherapy, including high-dose cisplatin. Its indication expanded in August 2002, with approval from the FDA for the prevention and treatment of postoperative nausea and vomiting. Granisetron strongly and selectively binds to the 5-HT(3) receptor with a binding constant of 0.26 nM and exhibits a 4000 - 40,000 times greater binding affinity for the 5-HT(3) receptor than other binding sites, including other 5HT subtypes and adrenergic, histaminergic and opioid receptors. ⋯ Granisetron has been shown to be an effective within-class rescue antiemetic for prophylactic failures, which may be linked to its pharmacological properties including non-competitive, insurmountable binding to the 5-HT(3) receptor. As with other 5-HT(3)-receptor antagonists, granisetron is well-tolerated with adverse events of mild severity including headache, asthenia and constipation. Overall, data demonstrate that granisetron is an efficacious, safe and cost-effective member of the 5HT(3)-receptor antagonist class for the prevention of CINV.
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Expert Opin Pharmacother · Sep 2003
Review Comparative StudyCost-effectiveness of different postoperative analgesic treatments.
Pain may produce metabolic changes after surgery, which may contribute to further morbidity. A variety of medicines and techniques can be used to successfully treat pain. ⋯ This article reviews the literature evaluating the cost-effectiveness of providing different types of postoperative analgesics and finds that most studies are so poorly conducted that they prevent definitive conclusions being made. The author suggests that further studies be done using analgesics as just one part of a multimodal rehabilitation approach with careful attention to defining outcome, costs and achieving sufficient power to find or exclude meaningful differences.
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Expert Opin Pharmacother · Sep 2003
Review Comparative StudyReview of bemiparin sodium--a new second-generation low molecular weight heparin and its applications in venous thromboembolism.
Bemiparin sodium (Hibor, Ivor, Zivor, Badyket, Laboratorios Farmaceuticos Rovi SA) is a new second-generation low molecular weight heparin (LMWH). Bemiparin has the lowest mean molecular weight (3600 Da), the longest half-life (5.3 h) and the largest antifactor Xa:antifactor IIa ratio (8:1) of all LMWHs. Bemiparin promotes a greater release of tissue factor pathway inhibitor than unfractionated heparin (UFH) or dalteparin. ⋯ Bemiparin was as effective as UFH for clot prevention during haemodialysis. The use of bemiparin was associated with a lower incidence of major and minor bleeding as compared to UFH in abdominal surgery. When compared with enoxaparin in orthopaedic surgery, a lower rate of complications at injection site was observed.
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Expert Opin Pharmacother · Sep 2003
Review Comparative StudyCost-benefit analysis of ivermectin, permethrin and benzyl benzoate in the management of infantile and childhood scabies.
In the US, 6% sulfur in petrolatum has been the most frequently administered treatment for infantile scabies. It appears to be safe but there is no literature containing a large series of patients on which to base that determination. In the UK, benzyl benzoate is the approved product. ⋯ It remains present on the skin for several days, therefore protecting against reinfestation. Ivermectin is a systemic drug which is assumed to be safe in infants, although it requires repeated doses and does not protect against reinfestation. In the opinion of the author, 5% permethrin is the best treatment for scabies in infants and young children.