March 2007 B BP PH

March 2007
BPH Symptoms May Improve With
Anticholinergics
Benign prostatic hyperplasia (BPH) is a very
common condition occurring in up to 70% of men
over the age of 60. Increased prostate size may
cause urinary hesitancy and intermittent, weak urine
flow. The bladder muscle (detrusor) compensates by
contracting more forcibly. Over time it is thought that
physical and biochemical changes occur to the
detrusor muscle which cause it to become
overactive. Consequently as many as 50% of men
with BPH also have an overactive bladder.
The alpha-1 blocker class of drugs is usually
prescribed for treating the symptoms of BPH (e.g.
doxazosin-Cardura, alfuzosin-Xatral, tamsulosin–
Flomax and terazosin-Hytrin). They work by relaxing
the smooth muscles in the neck of the bladder and
prostate thereby reducing the obstruction to urine
flow. They may also reduce the overactivity of the
bladder; however some men still experience
significant symptoms of urge incontinence, frequency
or urgency (symptoms of overactive bladder). For
this group of patients, the treatment of choice is the
anticholinergic (anti-muscarinic) group of drugs
which include tolteridone (Detrol) and oxybutynin
(Ditropan) and others. There is some concern
regarding prescribing anticholinergics to males with
an enlarged prostate. If significant bladder outflow
obstruction is present the risk of developing acute
urinary retention is increased with anticholinergic
administration.
Several studies evaluating the use of anticholinergics
(in combination with an alpha-1 blocker) in the
presence of BPH concluded that the risk of urinary
obstruction was very low when administered to
suitable patients. A significant number of men who
continued to experience symptoms of overactive
bladder on alpha-1 blocker therapy alone found that
the addition of an anticholinergic drug resulted in an
improvement of symptoms after a period
of about 12 weeks.
Men with poor urine flow due to a
severely enlarged prostate would not be
good candidates for combination
treatment.
If anticholinergics are
administered patients should be advised to report
“urgency that is accompanied by weak flow,
hesitancy or a feeling of incomplete emptying”.
Flu Shots for Children Receiving Their
First Vaccination
Children under the age of 9 who are receiving their
first influenza vaccine may not be adequately
protected if they do not get a second dose. A second
injection of the vaccine is required in children under
9 being vaccinated for the first time. The second
dose of the vaccine should be administered at an
interval of at least 4 weeks after the first dose in
order for the vaccine to be effective. Only one dose
of the vaccine is necessary if children have received
the influenza vaccine in the past.
Risperidone / Simvastatin Interaction
The concomitant use of risperidone (Risperdal) and
simvastatin (Zocor) may increase simvastatin levels
and the risk of myopathy or rhabdomyolysis. This
major interaction tends to have a delayed onset.
Although the combination of risperidone and
simvastatin is not recommended, if concurrent therapy
is considered necessary, the patient should be
monitored for signs and symptoms of myopathy or
rhabdomyolysis (i.e. muscle pain, tenderness or
weakness). Monitoring of creatinine kinase (CK) levels
is recommended. Concomitant use should be
discontinued if myopathy or rhabdomyolysis is
diagnosed or suspected or if CK levels show a marked
increase.
Fish Oil Supplements May Help With
Anxiety in Patients With History of
Substance Abuse … The Journal of Clinical
Psychopharmacology reported the results of a small
study demonstrating that men with a history of
substance abuse who had received a dose of 5
capsules daily of a branded fish oil supplement
containing 450 mg of EPA (eicosapentaenoic acid),
100 mg of DHA (docosahexaenoic acid) and 50 mg
of other omega-3 fatty acids experienced a
progressive and significant decline in anxiety scores.
Alvesco 100 mcg & 200 mcg
ciclesonide inhalation aerosol
Altana (not currently a benefit of ODB)
Alvesco, a corticosteroid for oral inhalation, is
indicated for the prophylactic management of steroid
responsive bronchial asthma in patients 18 years of
age and older. Ciclesonide is converted in the lungs
to its active form. It has a high degree of lung
availability and limited systemic exposure when used
at recommended doses.
Alvesco shares the warnings, precautions and
adverse effects of other inhaled corticosteroids.
Treatment with Alvesco should be tapered gradually,
not stopped abruptly. An impaired immune system
may cause patients to be more prone to thrush in the
mouth or throat. Patients with glaucoma or who are
at risk of glaucoma or ocular hypertension should
have their intraocular pressure monitored at
appropriate intervals with long-term therapy. In the
elderly the risk of developing cataracts may increase
in proportion to the daily and cumulative lifetime
exposure to inhaled corticosteroids. This risk is
further increased in smokers, ultraviolet-B exposure
and in people with diabetes. Inhaled therapy with
corticosteroids may also contribute to bone loss and
osteoporosis but to a much lesser degree than with
oral or parenteral therapy.
The most common adverse effects (occuring in less
than 2% of patients in clinical trials) included
paradoxical bronchospasm. Symptoms are
described as chest discomfort, chest pain, asthma,
bronchospasm, cough, dyspnea, obstructive airways
disorder and wheezing. Hoarseness was reported in
about 1% of patients.
Drug Interactions: Alvesco is metabolized by the
CYP3A4 enzyme to its active form. Coadministration
of Alvesco with drugs which inhibit the enzyme
cytochrome P450 3A4 (e.g. itraconazole, ritonavir,
nelfinavir) may increase the active metabolite of
Alvesco. The coadministration of ketoconazole in
clinical trials resulted in a 3.5 fold increase in the
active drug. It is unknown if a clinical adverse effect
may result. If the drugs must be coadministered
caution should be exercised.
Dose & Administration: The recommended dose of
Alvesco is 100 mcg to 800 mcg per day administered
as one or two puffs once daily either in the morning
or the evening. In more severe asthma where
patients require 800 mcg per day the drug may be
administered as 400 mcg twice daily. Doses should
be titrated according to individual response. Rinsing
and gargling with water is recommended after dosing
to minimize the overgrowth of micro-organisms.
Alvesco may be used with a spacer device (e.g. Aero
Chamber Plus). Prior to first use or if unused for 1
week or more, Alvesco should be primed by
releasing 3 puffs into the air. Alvesco is a solution
and therefore does not require shaking prior to use.
The mouthpiece should be cleaned with a dry tissue
or cloth on a weekly basis. No part of the inhaler
should be washed or placed in water.
Availability & Storage: Alvesco is available as a
100 mcg per actuation and a 200 mcg per actuation
canister containing 120 doses and a hydrofluoroalkane propellant. The recommended storage
temperature is 15° to 30° C. Avoid freezing.
Mirapex (pramipexole dihydrochloride)
Boehringer-Ingelheim … New Indication
Mirapex is now indicated for the symptomatic
treatment of moderate to severe idiopathic restless
leg syndrome. The recommended dose is 0.125 mg
once daily (without regard to meals) administered 2
to 3 hours before bedtime. After 4 to 7 days the dose
may be increased to 0.25 mg in the evening if
necessary. Additional dose titration to 0.5 mg in the
evening may be made following another 4 to 7 days.
Some patients require a dose of 0.75 mg daily. The
safety and efficacy of therapy has not been
evaluated beyond 12 weeks. If discontinuation is
necessary the dose should be tapered gradually at 4
to 7 day intervals.
Asaphen 81 mg (PendoPharm) - Name
Change … Asaphen 81 mg will undergo a name
change to Entrophen 81 mg. The tablets will be
available in enteric coated and chewable formats.
Log on to our new website
www.medicalpharmacies.com.
You can now read our newsletter on-line.