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.