Both patients and clinicians agree that nasogastric tube insertion is very painful. But now that topical anesthesia is available, Australian researchers point out, why not use it?
A double-blind, placebo-controlled trial from Royal Brisbane and Women’s Hospital, Royal Melbourne Hospital, and Austin Hospital, Australia, confirms that using topical anesthesia reduces the discomfort of nasogastric tube insertion. The researchers found a clinically and statistically significant difference between 29 patients who were given nebulized lidocaine and 21 patients receiving nebulized normal saline.
There was no detectable difference in the difficulty of inserting the tube, but five patients in the lidocaine group had nosebleeds. Lidocaine has not been associated with nosebleeds, but anesthetized turbinates might be more likely to be injured because they are relatively insensate. The researchers suggest adding a vasoconstricting agent.
DuPont has opened a new facility in Old Hickory, Tennessee to produce a nonwoven composite fabric (Suprel™). Used for hospital operating gowns and patient drapes, the fabric combines the strength of polyester and the softness of polyethylene. It offers greater freedom of movement and comfort for patients. buy requip
Tenofovir disoproxil fumarate (Viread, Gilead), an oral medication that inhibits retroviral replication, could have a new life as a convenient vaginal gel, say researchers from Harlem Hospital Center, Bronx-Lebanon Hospital/Center, University of Pennsylvania, and Miriam Hospital in Providence, Rhode Island.
In the first phase 1 clinical trial to evaluate an antiretroviral agent as a vaginal microbicide, tenofovir vaginal gel was well tolerated. The study included 60 HIV-negative women and 24 HIV-positive women.
The women used either 0.1% or 0.3% tenofovir gel for 14 consecutive days between menstrual periods. Adverse events were generally mild; most of the women and their male partners said that they would probably use the gel if it were available. Pharmacokinetic testing demonstrated that 14 of 25 women had detectable plasma levels of tenofovir at least once.
Longer-term studies are needed to determine whether the drug accumulates to toxic levels or whether tissue penetration enhances the gel’s protective effects. However, thousands of HIV-positive patients have tolerated daily tenofovir for up to five years.
None of the HIV-positive women with detectable plasma or cervicovaginal HIV RNA developed mutations associated with tenofovir resistance—a “reassuring” finding, the researchers note. Longer-term studies are recommended to evaluate chronic use.
A methylphenidate transdermal system (Daytrana, Shire) offers another option for children six to 12 years of age with Attention Deficit Hyperactivity Disorder (ADHD). This is the first non-oral medication for ADHD.
The patch, in strengths of 10, 15, 20 and 30 mg, is designed to be worn during a child’s normal daily activities. It should be applied daily to clean, dry, non-irritated skin. Because the body absorbs four times the amount of drug when the patch is heated, children should not sit in a hot bathtub or use a heating pad or electric blanket while they are wearing the patch. crestor drug
In clinical trials, wearing the patch for nine hours provided a 12-hour duration of effect. The patch is to be left on for nine hours, followed by 15 hours of non-wear, and alternate sites should be used. Parents must be advised to follow instructions carefully to prevent excess absorption of the medication. In 2003, the FDA rejected the ADHD patch in a 12-hour form because of an excess of adverse reactions.
The label will include warnings about insomnia, decreased appetite, and nausea.
Pramipexole dihydrochloride tablets (Mirapex, Boehringer Ingelheim) has been approved for the treatment of moderate-to-severe primary restless legs syndrome (RLS). RLS is a common neurological sensorimotor disorder. Patients typically describe an urge to move the legs, and they may experience burning, creeping, crawling, aching, tingling, or tugging sensations in the legs. Up to 10% of adults in the U.S. are affected.
Pramipexole is also approved to treat Parkinson’s disease.
Refrigerated FluMist live intranasal influenza virus vaccine (Medlmmune) has been approved. The vaccine is used to prevent influenza in healthy children and adolescents 5 to 17 years of age and in healthy adults 18 to 49 years of age.
The new formulation, called CAIV-T (cold-adapted influenza vaccine-trivalent), can be stored in a refrigerator rather than in a freezer, as previously required.
FluMist has been marketed in a frozen formulation since its original FDA approval in 2003. The new formulation will be available for the 2007-2008 influenza season. Both the frozen and refrigerated forms are free of preservatives, including thimerosal.
FluMist should never be injected.
The FDA has approved a New Drug Application (NDA) supplement to add intravenous (IV) use as a new route of administration for azacitidine (Vidaza, Pharmion). This agent, which is indicated for the treatment of myelodys-plastic syndromes (MDS), may now be infused over a period of 10 to 40 minutes in a clinic or hospital setting.
IV dosing remains the same as in the previous subcutaneous formulation, 75 mg/m2 daily for seven days every four weeks.
On May 19, 2004, azacitidine became the first drug approved by the FDA for MDS.
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Because this medication is associated with neutropenia and thrombocytopenia, complete blood counts should be performed as needed to monitor responses and toxicity.
Caution is needed for patients with impaired renal function.
Women should not breast-feed while taking azacitidine.