Drug and therapeutics bulletin
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Around 15% of all known pregnancies miscarry during the first trimester. Historically, first trimester miscarriage was managed surgically to remove all retained products of conception, with the aim of minimising the likelihood of blood loss and infection from retained tissue. Nowadays, medical management (use of drugs such as mifepristone and misoprostol) and expectant management (i.e. allowing the miscarriage to conclude naturally) have become alternatives to a surgical procedure for managing women with early miscarriage. Here, we review the evidence on these three methods to assess the benefits and disadvantages of each.
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Stroke is very common, with, for example, around 110,000 people each year in England alone experiencing a first or recurrent episode. Consequences of stroke can include disability and early death, and the condition costs the UK economy around 7 billion pounds annually. Around 70-80% of first strokes are ischaemic (i.e. due to the thromboembolic or thrombotic occlusion of an intracranial artery), and so some patients with stroke may be suitable for thrombolytic therapy. Here we review the evidence for such therapy in acute ischaemic stroke.
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Chlorofluorocarbon (CFC) compounds, the traditional propellants in aerosol metered-dose inhalers (MDIs), damage the ozone layer in the atmosphere. Following adoption of the Montreal Protocol on Substances that Deplete the Ozone Layer almost 20 years ago, the UK Government produced a transition strategy to enable CFC-containing MDIs to be phased out as quickly as possible.(1, 2) Hydrofluoroalkanes (HFAs) are now being used as propellants in most MDIs (i.e. CFC-free inhalers). ⋯ There are now two CFC-free beclometasone inhalers available in the UK - Qvar (Teva) and black triangle [see text for formula]Clenil Modulite (Trinity-Chiesi), both licensed for asthma. CFC-containing beclometasone MDIs will become unavailable as stocks run out (within the next year). Here we discuss the issues around switching to the CFC-free beclometasone inhalers.
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Each year in the UK, about 1 in 2,500 people experiences neuropathic pain that is still present 3-6 months after acute herpes zoster (shingles). This condition, known as postherpetic neuralgia, is the most common complication of herpes zoster and can be chronic, intractable and distressing. ⋯ Versatis (Grunenthal Ltd), a topical preparation of lidocaine formulated in a plaster, has recently been licensed for treating patients with postherpetic neuralgia. Does it offer useful benefit?
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Over 1 in 5 adults in the UK are estimated to have allergic rhinitis and around half of these people are allergic to grass pollen. Despite optimal use of intranasal corticosteroids and oral antihistamines, some patients continue to have troublesome symptoms. For example, in one general practice survey, 62% of patients taking both these treatments described control of their symptoms as partial or poor. ⋯ Sublingual immunotherapy has been proposed as an alternative to the subcutaneous route. Grazax (ALK-Abelló) is the first product licensed in the UK for sublingual immunotherapy. Here we consider its role in the management of patients with hay fever.