Drug and therapeutics bulletin
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Oseltamivir (pronounced os-el-ta-mi-veer; Tamiflu--Roche), an oral anti-influenza drug that inhibits influenza virus neuraminidase, is now available in the UK. It has recently been licensed throughout the EU for use, when influenza is circulating in the community, in the treatment of patients with early influenza-like symptoms, and for prophylaxis in people who have had close contact with someone with influenza. ⋯ Previously, we concluded that there was insufficient evidence that treatment with zanamivir prevented serious complications in people most at risk from influenza to recommend its use. Here we review the efficacy and safety of oseltamivir and discuss its role in the management of influenza.
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Clopidogrel (Plavix-Sanofi-Synthelabo & Bristol-Myers Squibb) blocks platelet aggregation through an action distinct from that of aspirin. In the UK, it is licensed for the secondary prevention of atherosclerotic events and for this, we concluded 3 years ago that clopidogrel "appears to offer no worthwhile advantage over aspirin". After publication of the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) trial, which assessed adjunctive use of clopidogrel with aspirin in patients with acute coronary syndrome without ST-segment elevation (unstable angina or non-Q wave infarction), clopidogrel was hailed in the lay media as "the biggest breakthrough in 20 years". Do the CURE study results warrant the use of clopidogrel in patients with acute coronary syndrome without ST elevation (currently an unlicensed indication)?
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Up to one-third of women in the UK have polycystic ovaries (i.e. 10 or more follicles per ovary detected on ultrasound). An estimated one-third of these women have polycystic ovary syndrome, usually defined in the UK as polycystic ovaries together with one or more characteristic features (hirsutism, male-pattern baldness, acne, oligomenorrhoea or amenorrhoea, obesity, or raised serum concentrations of testosterone and/or luteinising hormone [LH]). The metabolic abnormalities often associated with polycystic ovary syndrome (insulin resistance and abnormal serum lipid concentrations) also put some women with the syndrome at increased risk of developing diabetes mellitus. Here, we review the management of women with polycystic ovary syndrome.
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Neuropathic pain results from damage to or dysfunction in the nervous system. The term usually refers to pain caused by a primary abnormality in the peripheral nervous system, while pain caused by damage to the central nervous system tends to be called central pain. ⋯ Management, ideally in a multidisciplinary pain-relief clinic, often involves the combined use of a range of pharmacological and non-drug approaches, the latter including transcutaneous electrical nerve stimulation, psychological treatments, and specialist procedures to stimulate, block or destroy discrete areas of the nervous system. Here, we review just the drug treatments for neuropathic pain.
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In the UK around 1 in 5 children will have been diagnosed as having asthma at some stage before they reach 15 years old. The use of inhaled corticosteroids has done much to reduce morbidity in these children and current British Guidelines recommend the use of inhaled corticosteroids in all but mild childhood asthma. However, there are concerns about the long-term safety of such treatment in growing children, and the benefits and risks of their use need careful evaluation. In this article we review the place of inhaled corticosteroids in childhood asthma.