Expert opinion on drug safety
-
Expert Opin Drug Saf · May 2004
ReviewRisk-benefit of antiemetics in prevention and treatment of chemotherapy-induced nausea and vomiting.
The development of effective antiemetic prophylaxis is one of the most significant steps forward in the area of supportive care. Fifteen years ago, patients receiving chemotherapy had to face the fact that nausea and vomiting were inevitable adverse effects, which could only be partially prevented by treatment with antiemetics such as dopamine (DA) D2 receptor antagonists and corticosteroids. The first group of drugs specifically developed as antiemetics was the serotonin (5-hydroxytryptamine [5-HT](3)) receptor antagonists. ⋯ Guidelines are useful tools in the optimisation of antiemetic prophylaxis but, unfortunately, implementation of the evidence-based recommendations is far from successful. A prerequisite for further optimisation of antiemetic prophylaxis is updating of the guidelines, including recommendations for the use of NK 1 receptor antagonists (aprepitant), followed by implementation of these recommendations in the clinic. Future research must include 'the difficult trials' focusing on the remaining groups of patients with severe chemotherapy-induced nausea and vomiting, including patients with refractory and breakthrough emesis.
-
Expert Opin Drug Saf · May 2004
ReviewThe pharmacology of bipolar disorder during pregnancy and breastfeeding.
Treating bipolar disorder in women during reproduction presents a significant challenge to the physician. The pharmaceutical agents most commonly used for treating bipolar disorder have been associated with adverse effects when used during pregnancy and breastfeeding. Of particular concern has been the association of lithium with cardiac malformations, and the association of carbamazepine and valproate with neural tube defects including spina bifida. ⋯ Treatment options for mood stabilisation are either associated with risks of adverse events, have been used less frequently and their associated risks are unknown, or may not provide effective prophylaxis against recurrences of bipolar episodes. However, strategies are available that minimise the risk to the fetus and infant whilst still providing effective prophylaxis against bipolar disorder in the mother. Ideally, a treatment regimen tailored to suit the individual should consider both mother and baby and should be planned prior to conception.
-
Expert Opin Drug Saf · May 2004
EditorialMedication errors resulting from the confusion of drug names.
If drug names are similar, errors can occur. Problems arise when different drugs have similar names (whether proprietary or non-proprietary), when formulations with the same brand name contain different drugs, when the same drug is marketed in formulations with different names, and when drug names are abbreviated. ⋯ Before they write an unfamiliar name on a prescription, prescribers should check what they are prescribing and what other medications the patient is taking (patients should be familiar with their medicines), and pharmacists should check patients' medicines. At all times there should be good communication among those who prescribe, supply, and administer medicines, and those who take them.