Proton pump inhibitors and B12 deficiency: What to do now
We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).
The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency. This is in addition to previously documented concerns about reduced calcium absorption that can lead to osteoporosis, increased risk of pneumonia and increased risk of Clostridium difficile colitis.
It seems simple to ask patients to just stop ...
Source: Kevin, M.D. - Medical Weblog - December 20, 2013 Category: Family Physicians Tags: Meds GI Medications Source Type: blogs
FDA Asks Drugmakers: Where Are Those Pediatric Studies?
A decade ago, the Pediatric Research Equity Act was enacted and gave the FDA the authority to require drugmakers to complete studies in children for the same adult indications when existing medicines are expected to be used in a substantial number of youngsters (read more here). And last year, the agency was given the right to shame drugmakers that fail to comply.
And so, the FDA has now posted on its web site a batch of letters that were recently sent to drugmakers that have not sought or obtained a deferral extension; submitted a deferred pediatric study by a final due date or requested approval for a required pediatric ...
Source: Pharmalot - December 5, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
Chest pain and Bradycardia
An elderly male complained of chest pain. He had no previous cardiac history and was only on aspirin, a statin, and a proton pump inhibitor. He was hypotensive but in no distress and well perfused. Here is the prehospital ECG:The heart rate is 38. There are no p-waves and the baseline appears to fibrillate. Thus, there is new atrial fibrillation with a slow response. The ventricular rate is regular. The QRS is narrow. There is inferior ST elevation and ST depression in V1-V4. Diagnosis: Atrial Fibrillation with complete (3rd degree) AV block and inferoposterior STEMI.The medi...
Source: Dr. Smith's ECG Blog - September 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Pfizer's Umpteenth Settlement (for $491 Million Plus a Guilty Plea), but No Person Held Responsible
The world's largest research based pharmaceutical company was in court again, as reported by the New York Times, The drug maker Pfizer agreed to pay $491 million to settle criminal and civil charges over the illegal marketing of the kidney-transplant drug Rapamune, the Justice Department announced on Tuesday. In particular, The recent case centers on the practices of Wyeth Pharmaceuticals, which Pfizer acquired in 2009.Rapamune, which prevents the body’s immune system from rejecting a transplanted organ, was approved by the Food and Drug Administration in 1999 for use in patients receiving a kidney tra...
Source: Health Care Renewal - July 31, 2013 Category: Health Medicine and Bioethics Commentators Tags: Wyeth impunity crime marketing Pfizer whistle-blowers legal settlements Source Type: blogs
Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and mus...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
"Treasure" Ireland launches first "preferred drugs" list
Ireland has launched the country's first "preferred drugs" list, which identifies lansoprazole as the preferred proton pump inhibitor (PPI) and simvastatin as the preferred statin.
Products for the country's first-ever preferred drug initiative have been selected by Health Service Executive (HSE)'s recently-established Medicines Management Programme. The HSE says it is asking doctors to prescription lansoprazole (Takeda's Zoton FasTab) and simvastatin (Merck & Co's Zocor) in order to save money, both for patients who pay for their medications and to deliver savings of an estimated 15 million euros for the taxpayer.
PP...
Source: PharmaGossip - April 23, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs
The LITFL Review 091
Welcome to the in-depth 91st edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
EKG Videos
This weeks ripper is taken out by the master of ECG’s Amal Mattu. Each week he puts out a n...
Source: Life in the Fast Lane - January 15, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
Pfizer's Pfourteenth Settlement - a Small Reminder of Continuing Impunity
Well, that did not take long. Less than a month after its last legal settlements were announced, Pfizer had to settle again. The Details of the Settlement This case, involving charges filed by the Texas Attorney General, was only reported locally, e.g., here in the Houston Business Journal:The state of Texas will receive more than $36 million from two civil Medicaid fraud settlements with Pfizer Inc and Endo Pharmaceuticals, Attorney General Greg Abbott said Friday. Both companies will pay $18.17 million to the state, plus attorney fees and relator shares. The federal government is also entitled to a sha...
Source: Health Care Renewal - January 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation deception boards of directors impunity Pfizer legal settlements governance Source Type: blogs
