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Scottish Medicines Consortium
Scottish Medicines Consortium diclofenac 1% gel patches (Voltarol Gel PatchÒ) No. (199/05) Novartis 9 September 2005 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland. The advice is summarised as follows: ADVICE: following a full submission Diclofenac 1% gel patch (Voltarol Gel PatchÒ) is not recommended for use within NHS Scotland for the local symptomatic treatment of pain in epicondylitis and ankle sprain. Diclofenac gel patch provides analgesia similar to that obtained with a topical gel formulation of this drug. However, on a gram per gram basis, patches cost over 40% more than the gel formulation. Overleaf is the detailed advice on this product. Chairman, Scottish Medicines Consortium 1 Diclofenac 1% gel patch (Voltarol Gel Patch®) Licensed indication under review Local symptomatic treatment of pain in epicondylitis and ankle sprain in adults. Dosing information under review Epicondylitis: one application morning and night for up to fourteen days. Ankle sprain: one application per day for up to three days. UK launch date 1 October 2005 Comparator medications Conditions included in the indications of diclofenac 1% gel patch, epicondylitis (tennis elbow) and ankle sprain could be treated topically with gel formulations of other non-steroidal anti- inflammatory drugs (NSAIDs), including diclofenac, ibuprofen, piroxicam, ketoprofen and felbinac or systemically with oral formulations of these drugs -
Comparing the Effects of Salts of Diclofenac and Almioprofen with Aspirin on Serum Electrolytes, Creatinine and Urea Levels in Rabbits
Comparing the effects of salts of diclofenac and almioprofen with aspirin on serum electrolytes, creatinine and urea levels in rabbits Nawazish-i-Husain Syed*, Farnaz Zehra, Amir Ali Rizvi Syed, Sabiha Karim and Farrakh Zia Khan University College of Pharmacy, University of the Punjab, Lahore, Pakistan Abstract: The effects of diclofenac sodium, diclofenac potassium, alminoprofen and aspirin on serum electrolytes (serum Na+ and K+), urea and creatinine were compared in rabbits in acute and chronic phases of treatment. The data suggested that all the four drugs markedly increased the serum electrolytes, urea and creatinine levels in both post- treatment phases. In conclusion, present study does not present any advantage of diclofenac sodium over diclofenac potassium at electrolyte levels on short and long term treatment. Nevertheless, current data support the evidence of renal function impairment by all the four drug therapies used in the present study, which is generally caused by NSAIDS. Keywords: NSAIDs, renal function, serum electrolytes. INTRODUCTION were given fodder twice daily, while water was available ad libitum. Throughout the study, environmental Inflammatory diseases including rheumatoid arthritis and conditions remained constant. Rabbits were divided into osteoarthritis are initially treated with non-steroidal anti- five groups, each of six animals. Same group of animals inflammatory drugs (NSAIDS) (Patrono and Rocca, were used for acute and chronic phases of the study. In 2009). Previously, steroids were prescribed to manage the both studies, rabbits of each group were orally chronic inflammatory diseases, however, due to their administered diclofenac Na+, diclofenac K+, severe adverse effects, NSAIDS has become the first alminoprofen, acetyl salicylic acid in a doses of 2.5mg, choice to treat these diseases. -
Table S1: Sensitivity, Specificity, PPV, NPV, and F1 Score of NLP Vs. ICD for Identification of Symptoms for (A) Biome Developm
Table S1: Sensitivity, specificity, PPV, NPV, and F1 score of NLP vs. ICD for identification of symptoms for (A) BioMe development cohort; (B) BioMe validation cohort; (C) MIMIC-III; (D) 1 year of notes from patients in BioMe calculated using manual chart review. A) Fatigue Nausea and/or vomiting Anxiety Depression NLP (95% ICD (95% CI) P NLP (95% CI) ICD (95% CI) P NLP (95% CI) ICD (95% CI) P NLP (95% CI) ICD (95% CI) P CI) 0.99 (0.93- 0.59 (0.43- <0.00 0.25 (0.12- <0.00 <0.00 0.54 (0.33- Sensitivity 0.99 (0.9 – 1) 0.98 (0.88 -1) 0.3 (0.15-0.5) 0.85 (0.65-96) 0.02 1) 0.73) 1 0.42) 1 1 0.73) 0.57 (0.29- 0.9 (0.68- Specificity 0.89 (0.4-1) 0.75 (0.19-1) 0.68 0.97 (0.77-1) 0.03 0.98 (0.83-1) 0.22 0.81 (0.53-0.9) 0.96 (0.79-1) 0.06 0.82) 0.99) 0.99 (0.92- 0.86 (0.71- 0.94 (0.79- 0.79 (0.59- PPV 0.96 (0.82-1) 0.3 0.95 (0.66-1) 0.02 0.95 (0.66-1) 0.16 0.93 (0.68-1) 0.12 1) 0.95) 0.99) 0.92) 0.13 (0.03- <0.00 0.49 (0.33- <0.00 0.66 (0.48- NPV 0.89 (0.4-1) 0.007 0.94 (0.63-1) 0.34 (0.2-0.51) 0.97 (0.81-1) 0.86 (0.6-0.95) 0.04 0.35) 1 0.65) 1 0.81) <0.00 <0.00 <0.00 F1 Score 0.99 0.83 0.88 0.57 0.95 0.63 0.82 0.79 0.002 1 1 1 Itching Cramp Pain NLP (95% ICD (95% CI) P NLP (95% CI) ICD (95% CI) P NLP (95% CI) ICD (95% CI) P CI) 0.98 (0.86- 0.24 (0.09- <0.00 0.09 (0.01- <0.00 0.52 (0.37- <0.00 Sensitivity 0.98 (0.85-1) 0.99 (0.93-1) 1) 0.45) 1 0.29) 1 0.66) 1 0.89 (0.72- 0.5 (0.37- Specificity 0.96 (0.8-1) 0.98 (0.86-1) 0.68 0.98 (0.88-1) 0.18 0.5 (0-1) 1 0.98) 0.66) 0.88 (0.69- PPV 0.96 (0.8-1) 0.8 (0.54-1) 0.32 0.8 (0.16-1) 0.22 0.99 (0.93-1) 0.98 (0.87-1) NA* 0.97) 0.98 (0.85- 0.57 (0.41- <0.00 0.58 (0.43- <0.00 NPV 0.98 (0.86-1) 0.5 (0-1) 0.02 (0-0.08) NA* 1) 0.72) 1 0.72) 1 <0.00 <0.00 <0.00 F1 Score 0.97 0.56 0.91 0.28 0.99 0.68 1 1 1 *Denotes 95% confidence intervals and P values that could not be calculated due to insufficient cells in 2x2 tables. -
Health Reports for Mutual Recognition of Medical Prescriptions: State of Play
The information and views set out in this report are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. Executive Agency for Health and Consumers Health Reports for Mutual Recognition of Medical Prescriptions: State of Play 24 January 2012 Final Report Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Acknowledgements Matrix Insight Ltd would like to thank everyone who has contributed to this research. We are especially grateful to the following institutions for their support throughout the study: the Pharmaceutical Group of the European Union (PGEU) including their national member associations in Denmark, France, Germany, Greece, the Netherlands, Poland and the United Kingdom; the European Medical Association (EMANET); the Observatoire Social Européen (OSE); and The Netherlands Institute for Health Service Research (NIVEL). For questions about the report, please contact Dr Gabriele Birnberg ([email protected] ). Matrix Insight | 24 January 2012 2 Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Executive Summary This study has been carried out in the context of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross- border healthcare (CBHC). The CBHC Directive stipulates that the European Commission shall adopt measures to facilitate the recognition of prescriptions issued in another Member State (Article 11). At the time of submission of this report, the European Commission was preparing an impact assessment with regards to these measures, designed to help implement Article 11. -
Short Reports
Br Med J (Clin Res Ed): first published as 10.1136/bmj.287.6395.798 on 17 September 1983. Downloaded from 798 BRITISH MEDICAL JOURNAL VOLUME 287 17 SEPTEMBER 1983 SHORT REPORTS analgesic properties. The usual daily dosage is 400 mg. The amount Piroxicam poisoning of fentiazac absorbed after gastric lavage would probably be small and of little importance. Piroxicam is a potent non-steroidal anti-inflammatory drug. Ex- The main signs were altered consciousness and muscle twitchings. perience with overdosage is limited. We describe a patient who took The exact causes of these were unknown, but griseofulvin has been a large dose of piroxicam. associated with dizziness, mental confusion, irritability, and impaired coordination.2 Side effects of piroxicam have occasionally included headache and dizziness, although their incidences in double blind Case report comparative studies have been lower than those reported with indomethacin.3 Thus the drowsiness and muscle twitchings could not A 25 year old Chinese man weighing 46 kg was admitted to hospital be definitely attributed to piroxicam. about two hours after ingesting 56 capsules of 10 mg piroxicam, 97 tablets Gastrointestinal bleeding is usually the major side effect of most of 125 mg griseofulvin, and about 10 tablets of 100 mg fentiazac. He had been drugs. Piroxicam seemed to be well suffering from psoriatic arthropathy affecting both knee and ankle joints non-steroidal anti-inflammatory and had been taking piroxicam 30 mg daily for nine months. Other anal- tolerated since the patient did not complain of gastric discomfort or gesics, including aspirin, paracetamol, fentiazac, and indomethacin, had gastrointestinal bleeding despite a history of gastric erosions. -
)&F1y3x PHARMACEUTICAL APPENDIX to THE
)&f1y3X PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE )&f1y3X PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 3 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. Product CAS No. Product CAS No. ABAMECTIN 65195-55-3 ACTODIGIN 36983-69-4 ABANOQUIL 90402-40-7 ADAFENOXATE 82168-26-1 ABCIXIMAB 143653-53-6 ADAMEXINE 54785-02-3 ABECARNIL 111841-85-1 ADAPALENE 106685-40-9 ABITESARTAN 137882-98-5 ADAPROLOL 101479-70-3 ABLUKAST 96566-25-5 ADATANSERIN 127266-56-2 ABUNIDAZOLE 91017-58-2 ADEFOVIR 106941-25-7 ACADESINE 2627-69-2 ADELMIDROL 1675-66-7 ACAMPROSATE 77337-76-9 ADEMETIONINE 17176-17-9 ACAPRAZINE 55485-20-6 ADENOSINE PHOSPHATE 61-19-8 ACARBOSE 56180-94-0 ADIBENDAN 100510-33-6 ACEBROCHOL 514-50-1 ADICILLIN 525-94-0 ACEBURIC ACID 26976-72-7 ADIMOLOL 78459-19-5 ACEBUTOLOL 37517-30-9 ADINAZOLAM 37115-32-5 ACECAINIDE 32795-44-1 ADIPHENINE 64-95-9 ACECARBROMAL 77-66-7 ADIPIODONE 606-17-7 ACECLIDINE 827-61-2 ADITEREN 56066-19-4 ACECLOFENAC 89796-99-6 ADITOPRIM 56066-63-8 ACEDAPSONE 77-46-3 ADOSOPINE 88124-26-9 ACEDIASULFONE SODIUM 127-60-6 ADOZELESIN 110314-48-2 ACEDOBEN 556-08-1 ADRAFINIL 63547-13-7 ACEFLURANOL 80595-73-9 ADRENALONE -
Diclofenac Topical Patch Gel Solution Monograph
Diclofenac Topical Patch, Gel and Solution National Drug Monograph March 2016 VHA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The purpose of VA PBM Services drug monographs is to provide a focused drug review for making formulary decisions. Updates will be made when new clinical data warrant additional formulary discussion. Documents will be placed in the Archive section when the information is deemed to be no longer current. FDA Approval Information Description/Mechanism of Action Diclofenac is the only nonsteroidal antiinflammatory drug (NSAID) approved in the U.S. for topical application. The mechanism of diclofenac is believed to be inhibition of prostaglandin synthesis, primarily by nonselectively inhibiting cyclooxygenase. The agents covered in this review are the four diclofenac topical products approved for analgesic purposes: Diclofenac epolamine / hydroxyethylpyrrolidine patch (DEHP) 1.3% approved in January 2007 Diclofenac sodium topical gel 1%, approved in October 2007 Diclofenac sodium topical solution 1.5% with dimethyl sulfoxide (DMSO, 45.5% w/w), approved in November 2009 Diclofenac sodium topical solution 2% with dimethyl sulfoxide (DMSO, 45.5% w/w), approved in January 2014 Indication(s) Under Review in this document (may include off Solution 1.5% Solution 2% label) Patch 1.3% Gel 1% (Drops) (MDP) Topical treatment Relief of the pain of Treatment of signs Treatment of the Also see Table 1 Product Descriptions of acute pain due osteoarthritis of joints and symptoms of pain of below. to minor strains, amenable to topical osteoarthritis of the osteoarthritis of sprains, and treatment, such as the knee(s) the knee(s) contusions knees and those of the hands. -
Pharmacology on Your Palms CLASSIFICATION of the DRUGS
Pharmacology on your palms CLASSIFICATION OF THE DRUGS DRUGS FROM DRUGS AFFECTING THE ORGANS CHEMOTHERAPEUTIC DIFFERENT DRUGS AFFECTING THE NERVOUS SYSTEM AND TISSUES DRUGS PHARMACOLOGICAL GROUPS Drugs affecting peripheral Antitumor drugs Drugs affecting the cardiovascular Antimicrobial, antiviral, Drugs affecting the nervous system Antiallergic drugs system antiparasitic drugs central nervous system Drugs affecting the sensory Antidotes nerve endings Cardiac glycosides Antibiotics CNS DEPRESSANTS (AFFECTING THE Antihypertensive drugs Sulfonamides Analgesics (opioid, AFFERENT INNERVATION) Antianginal drugs Antituberculous drugs analgesics-antipyretics, Antiarrhythmic drugs Antihelminthic drugs NSAIDs) Local anaesthetics Antihyperlipidemic drugs Antifungal drugs Sedative and hypnotic Coating drugs Spasmolytics Antiviral drugs drugs Adsorbents Drugs affecting the excretory system Antimalarial drugs Tranquilizers Astringents Diuretics Antisyphilitic drugs Neuroleptics Expectorants Drugs affecting the hemopoietic system Antiseptics Anticonvulsants Irritant drugs Drugs affecting blood coagulation Disinfectants Antiparkinsonian drugs Drugs affecting peripheral Drugs affecting erythro- and leukopoiesis General anaesthetics neurotransmitter processes Drugs affecting the digestive system CNS STIMULANTS (AFFECTING THE Anorectic drugs Psychomotor stimulants EFFERENT PART OF THE Bitter stuffs. Drugs for replacement therapy Analeptics NERVOUS SYSTEM) Antiacid drugs Antidepressants Direct-acting-cholinomimetics Antiulcer drugs Nootropics (Cognitive -
Fatal Hepatitis Associated with Diclofenac
Gut: first published as 10.1136/gut.27.11.1390 on 1 November 1986. Downloaded from Gut, 1986, 27, 1390-1393 Case reports Fatal hepatitis associated with diclofenac E G BREEN, J McNICHOLL, E COSGROVE, J MCCABE, AND F M STEVENS From the Department of Medicine, Regional Hospital, Galway, Eire SUMMARY Non-steroidal anti-inflammatory agents (NSAIDS) are a well recognised cause of hepatotoxicity. Diclofenac, a relatively new NSAID, was first introduced into the UK in 1979. Five cases of hepatitis have recently been reported, principally in the French literature. -5 We report the first fulminant case of hepatitis in the English literature in a patient taking diclofenac and indomethacin. Diclofenac is a member of the arylalkanoic group of 100 mg per day for five weeks. Ferrous sulphate one NSAIDS (Fig. 1). Three other agents in this group tablet daily was added on 16 May. The patient was have been shown to be significantly hepatotoxic. admitted to hospital on 26 June. A week before this Ibufenac was withdrawn from circulation because of he had felt unwell with anorexia, nausea, abdominal the frequent rise in transaminases,6 7 the use of discomfort, and dark urine. On admission he was benoxaprofen was stopped in Britain after 10 icteric, the liver edge was palpable 4 cm below the patients died with hepatitis8 9 and more recently a costal margin and there were no signs of chronic fatal case of hepatitis due to pirprofen has been liver disease. Ultrasound showed early ascites with reported."' Early reports about diclofenac showed no obstruction of the biliary tract. -
The Use of Stems in the Selection of International Nonproprietary Names (INN) for Pharmaceutical Substances
WHO/PSM/QSM/2006.3 The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances 2006 Programme on International Nonproprietary Names (INN) Quality Assurance and Safety: Medicines Medicines Policy and Standards The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances FORMER DOCUMENT NUMBER: WHO/PHARM S/NOM 15 © World Health Organization 2006 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. -
Cross-Reactive Mechanism for the False Elevation of Free Triiodothyronine in the Patients Treated with Diclofenac
Endocrine Journal 2001, 48 (6), 717-722 NOTE Cross-Reactive Mechanism for the False Elevation of Free Triiodothyronine in the Patients Treated with Diclofenac KEIZO KASONO, HAJIME HIKINO*, SHINJI FUJINO**, NoBUYUKI TAKEMOTO*, TosHIHIRO KAI*, KIYosHI YAMAGUCHI***, FUMio KONISHI* AND MASANOBU KAWAKAMI Department of Endocrinology and Metabolism, Jichi Medical School, Omiya Medical Center, 1-847, Amanuma-cho, Saitama 330-8503, Japan *Department of Surgery , Jichi Medical School, Omiya Medical Center, 1-847, Amanuma-cho, Saitama 330-8503, Japan **Department of Pathology , Jichi Medical School, Omiya Medical Center, 1-847, Amanuma-cho, Saitama 330-8503, Japan ***Department of Neurology , Jichi Medical School, Omiya Medical Center, 1-847, Amanuma-cho, Saitama 330-8503, Japan Abstract. We report three cases of patients exhibiting a false elevation of serum free triiodothyronine (FT3) as a result of a cross-reaction with diclofenac. The first case is a 66-yr-old woman with a long history of rheumatoid arthritis (RA). The patient was receiving diclofenac for the treatment of her RA. The patient was subsequently diagnosed as having thyroid papillary adenocarcinoma and received a subtotal thyroidectomy. After the operation, the patient exhibited postoperative hypothyroidism except for a gradual elevation of FT3. The other two patients also exhibited an elevated serum FT3 level after the administration of diclofenac. Serum FT3 levels in these pa- tients decreased to normal or below normal after diclofenac administration was discontinued. In the first case, the elimination of immunoglobulin from the sera using polyethylene glycol precipitation did not reduce the FT3 level. In our hospital, Vitros ECi (enhanced chemiluminescence enzyme immunoassay) system and Vitros FT3 kit were used for FT3 assay. -
FORMULATION and EVALUATION of COLON TARGETED PELLETS of BUMADIZONE CALCIUM” Mr
THESIS ISSN: 2349-2678 Contents lists available at www.ijpba.in International Journal of Pharmaceutical and Biological Science Archive PubMed (National Library of Medicine ID: 101738825) Index Copernicus Value 2017: 71.80 Volume 7 Issue 3; May-June; 2019; Page No. 01-69 “FORMULATION AND EVALUATION OF COLON TARGETED PELLETS OF BUMADIZONE CALCIUM” Mr. Shah Akashkumar Nareshkumar1, Mr. Anil G. Raval2 1PG Research Scholar, Department of Pharmaceutics, Sharda School of Pharmacy, Pethapur, Gandhinagar, Gujarat 2Assistant Professor, Department of Pharmaceutics, Sharda School of Pharmacy, Pethapur, Gandhinagar, Gujarat ABSTRACT Aim: The aim of this study was to Formulation and Evaluation of colon targeted pellets of Bumadizone Calcium Objective: Bumadizone Calcium is an acetic acid derivative, having irritation in stomach. Bumadizone Calcium has short half-life (4hrs) and undergoes first pass metabolism. It is pH-dependent. This research work was carried out to improve the bioavailability, patient compliance on oral colon targeted drug delivery. Bumadizone Calcium sustained release enteric coated pellets were prepared, which minimize the release of drug in stomach for treatment of IBD formulated by Extrusion Spheronization process. Experimental work done: Enteric coated pellets prepared by Extrusion Spheronization technique. Eudragit S100, HPMC, PVP K30, and Ethyl Cellulose were used as rate controlling polymers. In this study, a pH dependent colon targeted enteric coated pellets was established using 32 full factorial design by giving enteric coating with Eudragit S100. Different Concentration of Eudragit S100 as an enteric coating material (4%, 5%, & %6) and PVP K30 as a Binder (0.5%, 1% & 1.5%) are taken for the measurements of % Drug Release that are performed by using USP dissolution 1 (Basket type) at 50 rpm.