DOCSLIB.ORG

Utah Medicaid Pharmacy and Therapeutics Committee Drug

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Utah Medicaid Pharmacy and Therapeutics Committee Drug Utah Medicaid Pharmacy and Therapeutics Committee Drug Class Review Non-Selective Oral Nonsteroidal Anti-Inflammatory Drugs AHFS Classification: 28:08.04.92 Other Nonsteroidal Anti-inflammatory Agents Diclofenac Etodolac Fenoprofen Flurbiprofen Ibuprofen Indomethacin Ketoprofen Ketorolac Mefenamic Acid Meloxicam Nabumetone Naproxen Oxaprozin Piroxicam Sulindac Tolmetin Final Report April 2018 Review prepared by: Elena Martinez Alonso, B.Pharm., Medical Writer Vicki Frydrych, B.Pharm., Pharm.D., Clinical Pharmacist Valerie Gonzales, Pharm.D., Clinical Pharmacist Joanita Lake, B.Pharm., MSc EBHC (Oxon), Research Assistant Professor, Clinical Pharmacist Michelle Fiander, MA, MLIS, Research Assistant Professor, Evidence Synthesis Librarian Joanne LaFleur, PharmD, MSPH, Associate Professor University of Utah College of Pharmacy University of Utah College of Pharmacy, Drug Regimen Review Center Copyright © 2018 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved 1 Contents Executive Summary ...................................................................................................................................... 3 Introduction ................................................................................................................................................... 6 Table 1. FDA-Approved Oral Non-selective NSAIDs......................................................................... 7 Table 2. FDA-Approved Indication for Oral Non-selective NSAIDs ................................................ 13 Disease Overview and Guideline Recommendations ............................................................................. 14 A) Disease Overview ....................................................................................................................... 14 B) Guideline Recommendations ...................................................................................................... 17 Table 3. Guideline Recommendations for Oral NSAIDs ................................................................... 18 Table 4. Clinical Practice Guidance with Less Methodological Rigor than Guidelines Included in Table 3 ................................................................................................................................................ 24 Pharmacology & Special Populations ......................................................................................................... 25 Table 5. In Vitro Selectivity Ratio for NSAIDs ................................................................................. 25 Table 6. Pharmacokinetics for Oral Non-selective NSAIDs .............................................................. 26 Table 7. Special Population Considerations for Oral Non-selective NSAIDs ................................... 29 Methods ...................................................................................................................................................... 33 Clinical Efficacy ......................................................................................................................................... 35 Figure 1. PRISMA flow diagram of the selection process ................................................................. 35 Figure 2. Head-to-Head Efficacy Evidence among Non-selective NSAIDs ...................................... 36 Safety .......................................................................................................................................................... 46 Table 8. Gastrointestinal Toxicity Risk: NSAID Evidence................................................................ 47 Table 9. Selection of NSAID agent based on patient´s cardiovascular and gastrointestinal risk ....... 49 Table 10: Cardiovascular Toxicity Risk: NSAID Evidence............................................................... 52 Table 11: Hepatic Toxicity Risk: NSAID Evidence .......................................................................... 55 Summary ..................................................................................................................................................... 57 Table 12. Evidence-Based Findings on the Comparative Effectiveness among Oral nsNSAIDs ...... 57 References ................................................................................................................................................... 60 Appendix A. FDA-Approved Nonopioid Analgesics ................................................................................. 73 Appendix B. NSAID Interactions ............................................................................................................... 74 Appendix C. Literature Search Strategies ................................................................................................... 76 Appendix D. Key Findings Reported in Systematic Reviews/Meta-Analyses ........................................... 91 Appendix E. Excluded References............................................................................................................ 100 2 Executive Summary Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used agents worldwide for the treatment of pain and inflammation associated with several inflammatory conditions such as osteoarthritis and low back pain. NSAIDs exhibit analgesic, anti-inflammatory, and antipyretic effects by inhibiting the action of cyclooxygenase (COX). Several safety concerns associated with the use of NSAIDs include gastrointestinal, cardiovascular, and renal adverse events. Most of the clinical guidelines for specific pain conditions (e.g., osteoarthritis, ankylosing spondylitis, gout, and low back pain) recommend the use of the NSAID class as efficacious, without specifying preference for any particular NSAID. NSAIDs differ in safety profiles and drug interaction. Guidelines emphasize that the selection of an NSAID should be based on the patient’s comorbidities (gastrointestinal and/or cardiovascular diseases) and use of concomitant drugs. The NSAID class includes the traditional agents (nonselective NSAIDs) such as ibuprofen and naproxen and the selective COX-2 inhibitors (coxibs) such as celecoxib. Among the nonselective NSAIDs, meloxicam, etodolac, and nabumetone are sometimes further classified as partially selective based on their partial selectivity to COX-2 over COX-1. This report reviews the comparative efficacy and safety of 16 oral non-selective NSAIDs (nsNSAIDs) for the treatment of mild to moderate pain, osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, bursitis, tendinitis, ankylosing spondylitis, dysmenorrhea, and gout: diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin. Diclofenac is available in 3 salt formulations (diclofenac acid, potassium, or sodium), and naproxen is available as naproxen and naproxen sodium. Each oral nsNSAID is available by prescription. Naproxen and ibuprofen are additionally available without prescription. Efficacy: Following a systematic literature search for direct head-to-head comparisons among nsNSAIDs, 29 publications representing 20 systematic reviews/meta-analyses (SR/MAs), 8 randomized controlled trials (RCTs), and 1 substudy of an RCT were identified. Meta-analyses were generally not performed because RCTs used different nsNSAID comparators, as well as different pain outcome parameters and/or assessment tools. Evidence from the majority of studies showed no significant efficacy differences among the various nsNSAIDs. Listed below is a summary of the available evidence by indication: Osteoarthritis: There was high-quality evidence (2 SR/MAs including many RCTs with consistent results) showing no significant differences in relieving osteoarthritis symptoms between partially selective NSAIDs (etodolac or meloxicam) compared to nsNSAIDs, or between various nsNSAIDs. One SR/MA showed less pain reduction with more withdrawals due to a lack of efficacy for meloxicam compared to nsNSAIDs (e.g., naproxen, diclofenac, nabumetone, or piroxicam). There was low-quality evidence from 2 short-term trials reporting no significant differences between nabumetome (partially selective NSAID) and nsNSAIDs. Rheumatoid arthritis: There was low- to moderate-quality evidence from 2 SRs and 1 RCT reporting no significant efficacy differences among nsNSAIDs. However, some differences in 3 specific outcomes were found among nsNSAIDs in the 2 SRs. One SR reported higher withdrawal rates due to a lack of efficacy with meloxicam compared to other nsNSAIDs (e.g., naproxen, diclofenac, nabumetone). Another SR showed flurbiprofen is statistically superior to ibuprofen in terms of articular pain relief, to indomethacin in terms of articular swelling reduction, and to naproxen, indomethacin, and ibuprofen regarding articular stiffness reduction. Juvenile arthritis (including juvenile idiopathic arthritis): There is insufficient evidence from 2 RCTs to confirm any difference among nsNSAID. Ankylosing spondylitis: There was low- to moderate-quality evidence (2 SRs including small studies with imprecise estimate of effect) showing no significant differences in pain and stiffness reduction among the nsNSAIDs. Acute gout: Moderate-quality evidence from 3 SRs showed similar efficacy in reducing acute gout pain among nsNSAIDs. Indomethacin, naproxen and sulindac are currently approved
Load more

Recommended publications
  • Meloxicam 15 Mg Orodispersible Tablets Meloxicam 15.0 Mg
    PACKAGE LEAFLET: INFORMATION FOR THE USER Meloxicam 15 mg Orodispersible Tablets Meloxicam 15.0 mg Read all of this leaflet carefully before you start taking may occur if you have serious blood loss or burns, surgery or low this medicine. fluid intake; Keep this leaflet. You may need to read it again. if you have ever been diagnosed with high potassium levels in If you have any further questions, please ask your doctor or the blood; pharmacist. Tell your doctor if you think any of these apply to you. This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are Warning the same as yours. Medicines such as these Meloxicam tablets may be If any of the side effects become serious, or if you notice associated with a small increased risk of heart attack or any side effects not listed in this leaflet, please tell your doctor or stroke. Any risk is more likely with high doses and prolonged pharmacist. treatment. Do not exceed the recommended dose or duration of treatment. IN THIS LEAFLET: Discuss your treatment with your doctor or pharmacist if you have heart problems, have previously had a stroke or you think you 1. What Meloxicam orodispersible tablets are and what might be at risk of conditions such as high blood pressure, they are used for diabetes or high cholesterol, or if you are a smoker. 2 . Before you take Meloxicam tablets 3. How to take Meloxicam tablets Taking other medicines When you are taking Meloxicam tablets, do not take any other 4.
    [Show full text]
  • This Table Summarizes Changes to the HF Qxq As of 10/11/2019 Question
    Updated HFS Instructions (QxQs) This table summarizes changes to the HF QxQ as of 10/11/2019 Question in HF QxQ Description of Changes in HF QXQ General Instructions, pg. 3 Clarification added to rules for history Q29.d.10., pg. 40 Clarification made on how to record pulmonary hypertention Q29.d.14., pg. 41 Clarification made on how to record diastolic dysfunction Q42., pg. 42 Clarification made on how to record troponin I Section VII: Medication, pg. 54 Clarificaiton made on how to record medications Appendix A, pg. 61 Updated list of medications Edoxaban (ACOAG, Generic) Lixiana (ACOAG, Trade) Prexxartan (ARB, Trade) INSTRUCTIONS FOR COMPLETING HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM HFS Version C, 10/1/2015 HFA Version D, 10/1/2015 HF QxQ, 10/11/2019 Table of Contents Page General Instructions……………………………………………………………….. 2 Specific Items………………………………………………………………………. 3 Section l: Screening for Decompensation………………………………….. 5 Section ll: History of Heart Failure…………………………………………... 10 Section lll: Medical History ………………………………………………….. 13 Section lV: Physical Exam - Vital Signs…………………………………….. 24 Section V: Physical Exam - Findings……………………………………….. 26 Section Vl: Diagnostic Tests…………………………………………………. 31 Section Vll: Biochemical Analyses………………………………………….. 48 Section Vlll: Interventions…………………………………………………….. 51 Section lX: Medications………………………………………………………. 54 Section X: Complications Following Events………………………………… 59 Section Xl: Administrative……………………………………………………. 60 Appendix A: ARIC Heart Failure/Cardiac Drugs: ………………………………. 61 Alphabetical Sort Appendix B: Potential Scenarios of the Onset of Heart………………………. 73 Failure Event or Decompensation HF QxQ 10/11/2019 Page 1 of 73 General Instructions The HFAA form was initially used for all discharges selected for HF surveillance. It was replaced by the HFAB and HFSA forms and then updated June 2012 with HFAC and HFSB.
    [Show full text]
  • Nsaids: Dare to Compare 1997
    NSAIDs TheRxFiles DARE TO COMPARE Produced by the Community Drug Utilization Program, a Saskatoon District Health/St. Paul's Hospital program July 1997 funded by Saskatchewan Health. For more information check v our website www.sdh.sk.ca/RxFiles or, contact Loren Regier C/O Pharmacy Department, Saskatoon City Hospital, 701 Queen St. Saskatoon, SK S7K 0M7, Ph (306)655-8506, Fax (306)655-8804; Email [email protected] We have come a long way from the days of willow Highlights bark. Today salicylates and non-steroidal anti- • All NSAIDs have similar efficacy and side inflammatory drugs (NSAIDs) comprise one of the effect profiles largest and most commonly prescribed groups of • In low risk patients, Ibuprofen and naproxen drugs worldwide.1 In Saskatchewan, over 20 may be first choice agents because they are different agents are available, accounting for more effective, well tolerated and inexpensive than 300,000 prescriptions and over $7 million in • Acetaminophen is the recommended first line sales each year (Saskatchewan Health-Drug Plan agent for osteoarthritis data 1996). Despite the wide selection, NSAIDs • are more alike than different. Although they do Misoprostol is the only approved agent for differ in chemical structure, pharmacokinetics, and prophylaxis of NSAID-induced ulcers and is to some degree pharmacodynamics, they share recommended in high risk patients if NSAIDS similar mechanisms of action, efficacy, and adverse cannot be avoided. effects. week or more to become established. For this EFFICACY reason, an adequate trial of 1-2 weeks should be NSAIDs work by inhibiting cyclooxygenase (COX) allowed before increasing the dose or changing to and subsequent prostaglandin synthesis as well as another NSAID.
    [Show full text]
  • MIRADON FPO Brand of Anisindione Tablets
    R 1 2 3 4 5 3 4 F-16099775 1898 ® MIRADON FPO brand of anisindione Tablets DESCRIPTION MIRADON Tablets contain a syn- thetic anticoagulant, anisindione, an indanedione derivative. Each tablet contains 50 mg anisin- dione. They also contain: corn starch, FD&C Red No. 3, gelatin, lactose, and hydrogenated cotton- seed oil. ACTIONS Like phenindione, to which it is re- lated chemically, anisindione exercises its thera- peutic action by reducing the prothrombin activity of the blood. INDICATIONS Anisindione is indicated for the prophylaxis and treatment of venous thrombosis and its extension, the treatment of atrial fibrilla- tion with embolization, the prophylaxis and treat- ment of pulmonary embolism, and as an adjunct in the treatment of coronary occlusion. CONTRAINDICATIONS All contraindications to oral anticoagulant therapy are relative rather than absolute. Contraindications should be evaluated for each patient, giving consideration to the need for and the benefits to be achieved by anticoagu- lant therapy, the potential dangers of hemor- rhage, the expected duration of therapy, and the quality of patient monitoring and compliance. Hemorrhagic Tendencies or Blood Dyscrasias: In general, oral anticoagulants are contraindi- cated in patients who are bleeding or who have hemorrhagic blood dyscrasias or hemorrhagic tendencies (eg, hemophilia, polycythemia vera, purpura, leukemia) or a history of bleeding dia- thesis. They are contraindicated in patients with recent cerebral hemorrhage, active ulceration of the gastrointestinal tract, including ulcerative colitis, or open ulcerative, traumatic, or surgical wounds. Oral anticoagulants may be contraindi- cated in patients with recent or contemplated brain, eye, or spinal cord surgery or prostatec- tomy, and in those undergoing regional or lumbar block anesthesia or continuous tube drainage of the small intestine.
    [Show full text]
  • Acute Renal Failure Associated with Diflunisal J. G. WHARTON D. 0
    Postgrad Med J: first published as 10.1136/pgmj.58.676.104 on 1 February 1982. Downloaded from Postgraduate Medical Journal (February 1982) 58, 104-105 Acute renal failure associated with diflunisal J. G. WHARTON D. 0. OLIVER B.Sc., M.R.C.P. F.R.C.P., F.R.A.C.P. M. S. DUNNILL F.R.C.P., F.R.C.Path. Renal Unit, Churchill Hospital, and Department of Pathology, John Radcliffe Hospital, Oxford Summary eosinophils 224 x 106/1; ESR 30 mm/hr; urea 305 The case of a 44-year-old man with acute oliguric mmol/l; creatinine 1651 ,Lmol/l; potassium 6-43 renal failure due to tubulo-interstitial nephritis after mmol/l; serum amylase 88 Somogyi units; urine 3 months' diflunisal is reported. The possible mecha- contained no casts; no red cells but 10 neutrophils, nisms are discussed. no eosinophils and no growth. Antistreptolysin 0 titre 50 i.u./ml; IgG 16-5 g/l; IgA 3-8 g/l; IgM 1.1 g/l antinuclear factor negative; C3 122 mg/dl, C4 54Protected by copyright. Introduction mg/dl; hepatitis B surface antigen negative; chest Diflunisal has been reported as causing acute radiograph, cardiomegaly plus congestion; intra- allergic interstitial nephritis (Chan et al., 1980) venous urogram with tomograms, no obstruction, resulting in acute oliguric renal failure. A case of poor nephrogram. A renal biopsy showed tubulo- acute renal failure due to tubulo-interstitial nephritis interstitial nephritis with no eosinophil infiltrate. after 3 months of diflunisal is reported here. Recently, Diflunisal had been stopped 2 days before admission phenylakalonic acids with analgesic and anti- to this renal unit.
    [Show full text]
  • Diclofenac Sodium Enteric-Coated Tablets) Tablets of 75 Mg Rx Only Prescribing Information
    ® Voltaren (diclofenac sodium enteric-coated tablets) Tablets of 75 mg Rx only Prescribing Information Cardiovascular Risk • NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk. (See WARNINGS.) • Voltaren® (diclofenac sodium enteric-coated tablets) is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). Gastrointestinal Risk • NSAIDs cause an increased risk of serious gastrointestinal adverse events including inflammation, bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events. (See WARNINGS.) DESCRIPTION Voltaren® (diclofenac sodium enteric-coated tablets) is a benzene-acetic acid derivative. Voltaren is available as delayed-release (enteric-coated) tablets of 75 mg (light pink) for oral administration. The chemical name is 2-[(2,6-dichlorophenyl)amino] benzeneacetic acid, monosodium salt. The molecular weight is 318.14. Its molecular formula is C14H10Cl2NNaO2, and it has the following structural formula The inactive ingredients in Voltaren include: hydroxypropyl methylcellulose, iron oxide, lactose, magnesium stearate, methacrylic acid copolymer, microcrystalline cellulose, polyethylene glycol, povidone, propylene glycol, sodium hydroxide, sodium starch glycolate, talc, titanium dioxide. CLINICAL PHARMACOLOGY Pharmacodynamics Voltaren® (diclofenac sodium enteric-coated tablets) is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of Voltaren, like that of other NSAIDs, is not completely understood but may be related to prostaglandin synthetase inhibition.
    [Show full text]
  • (Ketorolac Tromethamine Tablets) Rx Only WARNING TORADOL
    TORADOL ORAL (ketorolac tromethamine tablets) Rx only WARNING TORADOLORAL (ketorolac tromethamine), a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days in adults), management of moderately severe acute pain that requires analgesia at the opioid level and only as continuation treatment following IV or IM dosing of ketorolac tromethamine, if necessary. The total combined duration of use of TORADOLORAL and ketorolac tromethamine should not exceed 5 days. TORADOLORAL is not indicated for use in pediatric patients and it is NOT indicated for minor or chronic painful conditions. Increasing the dose of TORADOLORAL beyond a daily maximum of 40 mg in adults will not provide better efficacy but will increase the risk of developing serious adverse events. GASTROINTESTINAL RISK Ketorolac tromethamine, including TORADOL can cause peptic ulcers, gastrointestinal bleeding and/or perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Therefore, TORADOL is CONTRAINDICATED in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation, and in patients with a history of peptic ulcer disease or gastrointestinal bleeding. Elderly patients are at greater risk for serious gastrointestinal events (see WARNINGS). CARDIOVASCULAR RISK NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (see WARNINGS and CLINICAL STUDIES). TORADOL is CONTRAINDICATED for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS).
    [Show full text]
  • Non-Steroidal Anti-Inflammatory Drugs (Nsaids)* *See List of Prescription NSAID Nsaids Are Used to Treat Pain, Redness, Swelling, and Heat (Inflammation)
    Medication Guide Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)* *see list of prescription NSAID NSAIDs are used to treat pain, redness, swelling, and heat (inflammation). medicines at the end of this guide WHAT IS THE MOST IMPORTANT INFORMATION YOU SHOULD KNOW ABOUT NSAIDS? NSAIDs can increase the risk of kidney failure, gastrointestinal damage, heart attack or stroke. Heart Kidney Gastrointestinal Attack Damage Damage (GI) Never use right before or You should not take NSAIDs Beware of life-threatening after coronary bypass graft if you have one of these ulcers and bleeding that may ! (CABG) surgery. ! high-risk conditions: ! happen without warning. Your risk† of heart attack or • Kidney disease Your GI risk increases with: stroke increases if: • Diabetes • Taking medicines called corticosteroids • You have heart disease • High blood pressure and anticoagulants • Even with short-term use • You take water pills or pills with • Old age or having poor health † • Smoking and drinking alcohol low dose aspirin does not pose this risk names that end in ‘pril’ or ‘sartan’ Your health risks increase the longer you take NSAIDs WHO SHOULD NOT TAKE NSAIDS? Do talk to your doctor if you: Do not take NSAIDs if you: • have medical conditions • have had an allergic reaction to aspirin or other NSAID • are breastfeeding • are a pregnant woman late in your pregnancy • take more than one medication: show your health provider a list of all of your medicines — some may cause serious side effects when combined with NSAIDs. WHAT ARE SERIOUS SIDE EFFECTS YOU
    [Show full text]
  • Post Marketing Safety Data Analysis Reveals Increased Propensity For
    Post Marketing Safety Data Analysis Reveals Increased Propensity for Severe Cardiovascular and Cerebrovascular Side Effects in Patients Taking Celecoxib Compared to Other NSAIDs Aarti Patel, PharmD Candidate, Tigran Makunts, PharmD, Ruben Abagyan, Ph.D. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA ABSTRACT RESULTS Non-steroidal anti-inflammatory medications, NSAIDS, are commonly used Cardiovascular ADR Report Frequencies Cardiovascular ADR Report Frequencies Odds ratios of cardiovascular ADR worldwide for their analgesic and anti-inflammatory properties, and are deemed out of 100,202 NSAID Reports Among Male and Female Celecoxib Users among Celecoxib male users when safe for over the counter access. NSAIDS as a class have been associated with Myocardial Infarction 4.79 compared to female users cardiovascular, CV, cerebrovascular, CVA, and hypertension, side effects, with Cerebrovascular Accident 3.66 Cerebrovascular 9.69 Accident 11.23 rofecoxib being removed from the market due to these toxicities. However, the Chest Pain 0.85 Cerebrovascular Accident 1.18 risks of heart attack and stroke were deemed similar in all currently marketed Hypertension 0.73 Palpitations 0.49 1.77 NSAIDs. The growing concern over the potentially fatal CV and CVA warranted ADR Hypertension Hypertension 1.16 Hypotension 0.46 ADR 2.05 FEMALES further studies to quantify the associations these side effects. Here, we ADR Atrial Fibrillation MALES analyzed over twelve million reports in the FDA Adverse Event Reporting 0.29 Congestive Heart Failure 0.28 12.16 System, FAERS, to evaluate the reporting odds ratios of hypertension, Myocardial Infarction Myocardial Infarction 2.42 Tachycardia 0.25 myocardial infarction, and stroke in patients taking individual NSAIDs and 25.11 0 1 2 3 4 5 acetaminophen as monotherapy.
    [Show full text]
  • Arthritis Treatment Comparison Arthritis Treatment Comparison
    ARTHRITIS TREATMENT COMPARISON ARTHRITIS TREATMENT COMPARISON GENERIC OA of (BRAND) HOW SUPPLIED AS GA JIA JRA OA Knee PsA RA CHELATING AGENTS Penicillamine Cap: 250mg ✓ (Cuprimine) Penicillamine Tab: 250mg ✓ (Depen) CYCLIC POLYPEPTIDE IMMUNOSUPPRESSANTS Cyclosporine Cap: 25mg, 100mg; ✓ (Gengraf, Neoral) Sol: 100mg/mL CYCLOOXYGENASE-2 INHIBITORS Celecoxib Cap: 50mg, 100mg, ✓ ✓ ✓ ✓ (Celebrex) 200mg, 400mg DIHYDROFOLIC ACID REDUCTASE INHIBITORS Methotrexate Inj: 25mg/mL; ✓ ✓ Tab: 2.5mg Methotrexate Tab: 5mg, 7.5mg, ✓ ✓ (Trexall) 10mg, 15mg INTERLEUKIN RECEPTOR ANTAGONISTS Anakinra Inj: 100mg/0.67mL ✓ (Kineret) Tocilizumab Inj: 20mg/mL, ✓ ✓ (Actemra) 162mg/0.9mL GOLD COMPOUNDS Auranofin Cap: 3mg ✓ (Ridaura) Gold sodium thiomalate Inj: 50mg/mL ✓ ✓ (Myochrysine) HYALURONAN AND DERIVATIVES Hyaluronan Inj: 30mg/2mL ✓ (Orthovisc) Sodium hyaluronate Inj: 1% ✓ (Euflexxa) Sodium hyaluronate Inj: 10mg/mL ✓ (Hyalgan) Sodium hyaluronate Inj: 2.5mL ✓ (Supartz) HYLAN POLYMERS Hylan G-F 20 Inj: 8mg/mL ✓ (Synvisc, Synvisc One) KINASE INHIBITORS Tofacitinib Tab: 5mg ✓ (Xeljanz) MONOCLONAL ANTIBODIES Ustekinumab Inj: 45mg/0.5mL, ✓ (Stelara) 90mg/mL MONOCLONAL ANTIBODIES/CD20-BLOCKERS Rituximab Inj: 100mg/10mL, ✓ (Rituxan) 500mg/50mL (Continued) ARTHRITIS TREATMENT COMPARISON GENERIC OA of (BRAND) HOW SUPPLIED AS GA JIA JRA OA Knee PsA RA MONOCLONAL ANTIBODIES/TNF-BLOCKERS Adalimumab Inj: 20mg/0.4mL, ✓ ✓ ✓ ✓ (Humira) 40mg/0.8mL Golimumab Inj: 50mg/0.5mL, ✓ ✓ ✓ (Simponi) 100mg/mL Infliximab Inj: 100mg ✓ ✓ ✓ (Remicade) NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2009/0005722 A1 Jennings-Spring (43) Pub
    US 20090005722A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2009/0005722 A1 Jennings-Spring (43) Pub. Date: Jan. 1, 2009 (54) SKIN-CONTACTING-ADHESIVE FREE Publication Classification DRESSING (51) Int. Cl. Inventor: Barbara Jennings-Spring, Jupiter, A61N L/30 (2006.01) (76) A6F I3/00 (2006.01) FL (US) A6IL I5/00 (2006.01) Correspondence Address: AOIG 7/06 (2006.01) Irving M. Fishman AOIG 7/04 (2006.01) c/o Cohen, Tauber, Spievack and Wagner (52) U.S. Cl. .................. 604/20: 602/43: 602/48; 4771.5; Suite 2400, 420 Lexington Avenue 47/13 New York, NY 10170 (US) (57) ABSTRACT (21) Appl. No.: 12/231,104 A dressing having a flexible sleeve shaped to accommodate a Substantially cylindrical body portion, the sleeve having a (22) Filed: Aug. 29, 2008 lining which is substantially non-adherent to the body part being bandaged and having a peripheral securement means Related U.S. Application Data which attaches two peripheral portions to each other without (63) Continuation-in-part of application No. 1 1/434,689, those portions being circumferentially adhered to the sleeve filed on May 16, 2006. portion. Patent Application Publication Jan. 1, 2009 Sheet 1 of 9 US 2009/0005722 A1 Patent Application Publication Jan. 1, 2009 Sheet 2 of 9 US 2009/0005722 A1 10 8 F.G. 5 Patent Application Publication Jan. 1, 2009 Sheet 3 of 9 US 2009/0005722 A1 13 FIG.6 2 - Y TIII Till "T fift 11 10 FIG.7 8 13 6 - 12 - Timir" "in "in "MINIII.
    [Show full text]
  • DAYPRO ALTA™ (Oxaprozin Potassium) 600Mg Tablets Cardiovascular Risk • Nsaids May Cause an Increased Risk of Serious Cardiov
    DAYPRO ALTA™ (oxaprozin potassium) 600mg tablets Cardiovascular Risk NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patient’s with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (see WARNINGS). Daypro ALTA is contraindicated for treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). Gastrointestinal Risk NSAID’s cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events (see WARNINGS). DESCRIPTION DAYPRO ALTA (oxaprozin potassium tablets) is a member of the propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). Each blue, capsule-shaped tablet contains oxaprozin potassium (678mg equivalent to 600mg of oxaprozin) for oral administration. The chemical name for oxaprozin potassium is 4,5-diphenyl-2-oxazolepropionic acid, potassium salt. Its empirical formula is C18H14NO3K, and molecular weight is 331. Oxaprozin potassium is a white to off white powder with a melting point of 215°C. It is slightly soluble in alcohol and very soluble in water. The PK in water is 9.7. It has the following structural formula: Inactive ingredients in DAYPRO ALTA tablets include microcrystalline cellulose, hydroxypropyl methylcellulose, pregelatinized corn starch, stearic acid, colloidal silicon dioxide, polyethylene glycol, titanium dioxide, FD&C Blue #1 Aluminum Lake, and pharmaceutical glaze.
    [Show full text]