Clinical drug investigation
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NSAIDs and cyclo-oxgenase (COX)-2-selective inhibitors have been associated with gastrointestinal (GI) complications among the elderly. It is recommended that gastroprotective drugs (i.e. misoprostol, proton pump inhibitors or high doses of histamine H2 receptor antagonists) be taken concomitantly to prevent NSAID-induced GI complications among older people. However, there are concerns that the rate of concomitant use of gastroprotective drugs in elderly NSAID users is too low. This study aimed to investigate the extent to which elderly users of NSAIDs/COX-2-selective inhibitors are concurrently taking gastroprotective drugs, and to determine the factors associated with concomitant use of gastroprotective drugs and NSAIDs/COX-2-selective inhibitors in a nationwide population of older people. ⋯ Our results indicate that gastroprotective drugs are not prescribed to elderly NSAID users according to guidelines. Furthermore, COX-2-selective inhibitors were used with gastroprotective drugs more often than were traditional NSAIDs. Greater awareness of factors contributing to NSAID/COX-2-selective inhibitor-induced GI complications is warranted, particularly with respect to advanced age and concurrent use of anticoagulants.
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Influenza is a common respiratory disease occurring in seasonal patterns, and may lead to severe complications in frail populations such as the elderly. In Poland, influenza vaccination is recommended for people aged ≥65 years; however the vaccine coverage rate in the elderly is very low. The fact that influenza vaccine is neither reimbursed by the National Health Insurance (Narodowy Fundusz Zdrowia [NFZ]) nor financed via a National Immunization Program (NIP) could be a reason for the low coverage rate. This study assessed the cost effectiveness of the full reimbursement of an influenza vaccination programme in Poland for people aged ≥65 years. ⋯ Implementing a vaccination programme in Poland in which influenza vaccination would be fully reimbursed by the NFZ for people aged ≥65 years would be a very cost-effective strategy.
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A 62-year-old man with no drug allergies was admitted for coronary artery bypass grafting. Postoperatively, metoclopramide was commenced for the treatment of gastroparesis. Ten days after the drug was initiated a purpuric rash was noticed on his lower limbs. ⋯ The rash later began to subside upon discontinuation of metoclopramide. A rechallenge was not attempted for ethical reasons. In conclusion, metoclopramide was considered to be the causative agent of this rash as it subsided after the discontinuation of metoclopramide.
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Intramuscular 17 α-hydroxyprogesterone caproate (Makena(®)), a synthetic progestin, is indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of a singleton spontaneous preterm birth. Makena(®) reduces the risk of preterm birth in this patient population, and is associated with improvements in certain fetal/neonatal outcomes. The use of this US FDA-approved formulation of 17 α-hydroxyprogesterone caproate reduces the inherent risks associated with the use of pharmacy-compounded formulations of the drug.
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Propofol is approved both for anaesthesia and sedation during intensive care. Serious adverse reactions with propofol have recently been reported, but patient exposure to the drug is unknown. ⋯ The use of propofol is increasing in Finland. Half of the propofol was used in anaesthesia units and half in intensive care units. We propose the following defined daily doses: 175mg for anaesthesia induction; 750 mg/patient-hour for anaesthesia maintenance; and 4200 mg/patient-day for sedation in intensive care.M.