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At least 289 records · Page 16Linked to original sources
PubMed1997

The calcium antagonist controversy: the emerging importance of drug formulation as a determinant of risk.

Calcium antagonists are one of the widely available classes of antihypertensive agents. Their broad appeal is attributable to several features, including their efficacy, their beneficial characteristics such as metabolic neutrality, and the occurrence of relatively few nuisance-type side effects. Despite these attributes, a number of retrospective analyses have suggested that calcium antagonists may be detrimental and may both promote adverse cardiovascular events and increase the risk of cancer by interfering with cellular apoptosis. On the basis of this and other retrospective analyses, Furberg and Psaty (Am J Hypertens 1996; 9: 122-125) have proposed that the use of calcium antagonists as first-line antihypertensive agents should be discontinued. I have previously countered these allegations and have suggested that they are not relevant to the newer calcium antagonist formulations in current use. It is not widely appreciated that different formulations of the same chemical moiety can produce markedly different hemodynamic and neurohormonal effects, due to differences in the rate of drug delivery into the systemic circulation. During chronic treatment with dihydropyridine calcium antagonists, major fluctuations in blood pressure (rapid onset and offset of antihypertensive effects) during the dosing interval may occur for drugs and formulations that are short acting. In contrast, slow-release formulations of otherwise rapidly absorbed dihydropyridines achieve a more gradual and sustained antihypertensive effect. It is probable that newer calcium antagonist formulations that are truly once daily and do not provoke intermittent sympathetic activation or a cardioacceleratory response will not promote adverse cardiovascular events.

Calcium Channel Blockers↗
PubMed2002

Cost burden of viral respiratory infections: issues for formulary decision makers.

Viral respiratory infections (VRIs) are a common malady associated with considerable costs in terms of decreased productivity and time lost from work or school, visits to health-care providers, and the amount of drugs prescribed. Both total respiratory illness and rhinovirus infection peak during the fall and spring seasons, although the average percentage of office visits by patients with a rhinovirus infection is moderately high throughout the year. Most common cold remedies are relatively ineffective and may produce side effects that contribute to increased health-care costs. Antibiotic therapy is widely overused and misused despite evidence that antibiotics fail to treat the cause of VRI or prevent secondary bacterial infections. Increasing use of antibiotics has a significant impact on health-care costs and the emergence of antimicrobial resistance. Reasons for overprescribing antibiotics are varied, but they often involve physician and patient attitudes and expectations. Although treatment of VRIs poses challenges for effective formulary management, several steps can be taken to facilitate the introduction of antiviral agents, including patient and provider education, the development of rapid diagnostic tests, and medical-economics studies to determine the true cost of antiviral therapy.

Anti-Bacterial Agents↗
PubMed1992

Reformulation and drop size of apraclonidine hydrochloride.

We performed a prospective, double-masked, placebo-controlled, six-period, cross-over study in which normal subjects were randomly assigned to treatment and compared three different formulations of apraclonidine hydrochloride (the present commercially available formulation, and formulations with hydroxypropylmethylcellulose or lysolecithin). We also evaluated the efficacy of a 16-microliters and 30-microliters drop size. The magnitude and duration of decrease in intraocular pressure was comparable for all formulations. Most subjects tolerated all formulations well with only a few reporting any side effects. The best-tolerated formulation was 0.5% apraclonidine hydrochloride delivered with a 16-microliters drop size. Dry mouth developed frequently with the commercially available 1% apraclonidine solution. Blurred vision complicated the use of the formulation containing hydroxypropylmethylcellulose. Both dry mouth (P less than .05) and blurred vision (P = .004) were statistically significant side effects.

Adrenergic alpha-Agonists↗