Red Alert

Red Alert

Sildenafil should be avoided in valve disease with residual pulmonary hypertension

Sildenafil should not be used to treat residual hypertension in patients with valvular heart disease, according to a latest research find up. Pulmonary hypertension refers to increased blood pressure in the pulmonary artery. In patients with long-standing valvular disease, the high pressure in the left side of the heart is transmitted backwards to the lung vessels which react by thickening. This process may not revert after valve treatment, resulting in persistent pulmonary hypertension.

 Ibuprofen associated with blood pressure risein arthritis patients at cardiovascular risk

Ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis and increased risk of cardiovascular disease, according to a new research findings. Nonsteroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but are linked with increased blood pressure and adverse cardiovascular events.

 Use of ACE inhibitors with ARBs Risky

Combined use of two drugs that act on renin angiotensin system (RAS) i.e. a member of ACE inhibitors along with a member of Angiotensin II Receptors Blockers (ARBs) is associated with increased risks of hypotension, hyperkalaemia and changes in renal function (including acute renal failure) compared to monotherapy. Most patients receiving the combination of two RAS inhibitors (such as enalapril or lisinopril with losartan or telmisartan) do not obtain any additional benefit compared to monotherapy. Hence, combined or concurrent use of Ace inhibitors with ARBs should be avoided. Use of drugs that act on the RAS during second and third trimesters of pregnancy reduce foetal renal function and increase foetal and reonatal morbidity and death.

 No benefit of Paracetamol with Ibuprofen FDC

The Fixed Dose Combination (FDC) of paracetamol with Ibuprofen is no better than either paracetamol or ibuprofen taken alone in relief of musculo-skeletal pain according to a double blind, randomized controlled trial undertaking at the Department of Emergency Medicine, Stony Brook University, New York. A total of 90 patients were administered either ibuprofen 800mg or paracetamol 1g or FDC of both. There was no difference in the relief of pain among the three groups. Side effects of FDC are more by consuming two drugs together than individual ingredients.

Oral Ketoconazole banned in Europe

Due to risk of severe liver injury oral ketoconazole has been banned in all the member states of the European Union. The decision was taken after detailed review following the drug’s ban by the French medicine regulator, the National Agency for the Safety of Medicines and Health Products (ANSM). Though hepatotoxicity is a class effect with azole antifungals but incidence and seriousness is higher in case of ketoconazole including hepatitis, cirrhosis and liver failure with fatal outcome requiring liver transplantation. The onset of hepatotoxicity has been reported as early as one month after use. The efficacy studies on ketoconazole are limited. Safer alternatives are available.

 Do not use Repaglinide & Clopidogrel together

Health Canada has warned prescribers and patients against concurrent use of Repaglinide (indicated in the treatment of diabetes sold under trade names of Regan, Repilin etc.) and Clopidogrel, (a medication meant to prevent heart attacks & strokes sold in India under the trade names of Plavix, Clopilet, Clopid, Noklot etc.) under any circumstances due to risk of severe hypoglycaemia levels due to a drug-drug interaction. In a study conducted with healthy volunteers, co-administration of clopidogrel (300mg on day 1, followed by 75mg daily for 2 consecutive days), and repaglinide (single dose of 0.25mg on day 1 and day 3) resulted in an increase in repaglinide systemic exposure by 5.1 fold and 3.9 fold on day 1 and day 3 respectively. Hypoglycaemia was noted in health volunteers on day 1 (3.3mmol/L) and on day 3 (3.9mmol/L).

  Dhaka -

Friday 15 Dec 2017

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