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Migraine Prophylaxis: Which Drugs Work and Which Ones Don't
Migraine Prophylaxis: Which Drugs Work and Which Ones Don’t Hans-Christoph Diener, MD Department of Neurology, University Hospital Essen, Essen, Germany. J Gen Intern Med 28(9):1125–6 investigated in two properly powered and conducted studies DOI: 10.1007/s11606-013-2469-2 and found not to be effective compared to placebo.3, 4 Adding © Society of General Internal Medicine 2013 data from poorly controlled and underpowered studies in a meta-analysis, as in this paper, gives the wrong impression that he paper by Shamliyan et al.1 in this issue of JGIM is a very nimodipine is as effective in migraine prevention as propran- T important contribution to headache research. The authors olol. Another example illustrated in this meta-analysis involves conducted a systematic literature review of drug treatment for the gabapentin. Most of the published trials are poorly conducted, underpowered, or have manipulated statistical analyses, such as prevention of episodic migraine. They analysed randomised 5 controlled trials (RCTs) and performed meta-analyses where modified intention-to-treat analyses. The meta-analysis in this appropriate. The two important outcomes examined in the paper indicated possible efficacy. Yet, in the time between the analysis are a ≥ 50 % reduction in migraine frequency and submission and publication of this paper, a recent well-powered adverse events leading to treatment discontinuation. dose finding trial was published investigating four doses of gabapentin as compared with placebo for migraine prevention. 6 What are the strengths of this paper? This trial showed no benefit for gabapentin. Another problem inherent in meta-analyses that this paper The authors are experts in this kind of analysis. -
Optum Essential Health Benefits Enhanced Formulary PDL January
PENICILLINS ketorolac tromethamineQL GENERIC mefenamic acid amoxicillin/clavulanate potassium nabumetone amoxicillin/clavulanate potassium ER naproxen January 2016 ampicillin naproxen sodium ampicillin sodium naproxen sodium CR ESSENTIAL HEALTH BENEFITS ampicillin-sulbactam naproxen sodium ER ENHANCED PREFERRED DRUG LIST nafcillin sodium naproxen DR The Optum Preferred Drug List is a guide identifying oxacillin sodium oxaprozin preferred brand-name medicines within select penicillin G potassium piroxicam therapeutic categories. The Preferred Drug List may piperacillin sodium/ tazobactam sulindac not include all drugs covered by your prescription sodium tolmetin sodium drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition piperacillin sodium/tazobactam Fenoprofen Calcium sodium to categories not listed, and should be considered Meclofenamate Sodium piperacillin/tazobactam as the first line of prescribing. Tolmetin Sodium Amoxicillin/Clavulanate Potassium LOW COST GENERIC PREFERRED For benefit coverage or restrictions please check indomethacin your benefit plan document(s). This listing is revised Augmentin meloxicam periodically as new drugs and new prescribing LOW COST GENERIC naproxen kit information becomes available. It is recommended amoxicillin that you bring this list of medications when you or a dicloxacillin sodium CARDIOVASCULAR covered family member sees a physician or other penicillin v potassium ACE-INHIBITORS healthcare provider. GENERIC QUINOLONES captopril ANTI-INFECTIVES -
Neurontin (Gabapentin)
Texas Prior Authorization Program Clinical Criteria Drug/Drug Class Gabapentin Clinical Criteria Information Included in this Document Neurontin (gabapentin) • Drugs requiring prior authorization: the list of drugs requiring prior authorization for this clinical criteria • Prior authorization criteria logic: a description of how the prior authorization request will be evaluated against the clinical criteria rules • Logic diagram: a visual depiction of the clinical criteria logic • Supporting tables: a collection of information associated with the steps within the criteria (diagnosis codes, procedure codes, and therapy codes); provided when applicable • References: clinical publications and sources relevant to this clinical criteria Note: Click the hyperlink to navigate directly to that section. Gralise (gabapentin Extended Release) • Drugs requiring prior authorization: the list of drugs requiring prior authorization for this clinical criteria • Prior authorization criteria logic: a description of how the prior authorization request will be evaluated against the clinical criteria rules • Logic diagram: a visual depiction of the clinical criteria logic • Supporting tables: a collection of information associated with the steps within the criteria (diagnosis codes, procedure codes, and therapy codes); provided when applicable • References: clinical publications and sources relevant to this clinical criteria Note: Click the hyperlink to navigate directly to that section. March 29, 2019 Copyright © 2019 Health Information Designs, LLC 1 Horizant -
Medication Choice Diabetes
Weight Change Low Blood Sugar Blood Sugar Considerations (Hypoglycemia) Blood(A1c Reduction) Sugar Weight Change Low Blood Sugar (A1c Reduction) Considerations (Hypoglycemia) Metformin Metformin Metformin 1 – 2% Metformin In the rst few weeks after starting Metformin, patients may have some nausea, indigestion or diarrhea. None No Severe Risk Minor = 0 – 1% Insulin There are no other side effects associated with Insulin. Insulin Insulin Insulin Unlimited % Pioglitazone 4 to 6 lb. gain Over time, 10 in 100 people may have fluid retention Severe = 1 – 3% Minor = 30 – 40% (edema) while taking the drug. For some it may be as little as ankle swelling. For others, fluid may build up Pioglitazone 1% in the lungs making it difficult to breathe. This may Pioglitazone Pioglitazone resolve after you stop taking the drug. 10 in 100 people at risk of bone fractures who use this drug will have More than 2 to 6 lb. gain a bone fracture in the next 10 years. There appears to No Severe Risk Minor = 1 – 2% be a slight increase in the risk of bladder cancer with Liraglutide/ 0.5 – 1% this drug. Liraglutide/Exenatide Liraglutide/Exenatide Exenatide Liraglutide/Exenatide Some patients may have nausea or diarrhea. In some 3 to 6 lb. loss cases, the nausea may be severe enough that a patient No Severe Risk Minor = 0 – 1% has to stop taking the drug. There are reports of pain in the abdomen that may be caused by inammation Sulfonylureas Sulfonylureas Sulfonylureas 1 – 2% of the pancreas with these agents. Glipizide, Glimepiride, Glyburide Glipizide, Glimepiride, Glyburide Glipizide, Glimepiride, Glyburide Sulfonylureas 2 to 3 lb. -
Association Between Serious Hypoglycemia and Calcium-Channel Blockers Used Concomitantly with Insulin Secretagogues
Research Letter | Diabetes and Endocrinology Association Between Serious Hypoglycemia and Calcium-Channel Blockers Used Concomitantly With Insulin Secretagogues Young Hee Nam, PhD; Colleen M. Brensinger, MS; Warren B. Bilker, PhD; James H. Flory, MD; Charles E. Leonard, MSCE, PharmD; Sean Hennessy, PhD, PharmD Introduction + Supplemental content Serious hypoglycemia is a major, potentially fatal adverse event caused by insulin secretagogues.1 Author affiliations and article information are Previous case reports suggested that calcium-channel blockers (CCBs) might reduce the risk of listed at the end of this article. serious hypoglycemia in patients with hyperinsulinemic hypoglycemia.2,3 However, the association of serious hypoglycemia and CCBs used with insulin secretagogues has remained unclear. Because insulin secretion by the pancreas is mediated by calcium influx in beta cells through calcium channels,4 we conducted a population-based observational study on the hypothesis that concomitant use of CCBs may be associated with reduced rates of serious hypoglycemia in insulin secretagogue users. Methods This self-controlled case series study was approved by the institutional review board of the University of Pennsylvania, which waived the requirement for informed consent because the use or disclosure of the protected health information involved no more than minimal risk to the privacy of individuals, and the research could not practicably be conducted without the waiver or alteration and without access to and use of the protected health information. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. We used claims data from the Medicaid programs of 5 US states (California, Florida, New York, Ohio, and Pennsylvania, encompassing more than a third of the nationwide Medicaid population), supplemented with Medicare claims for dual enrollees, from January 1, 1999, to December 31, 2011, and used the self- controlled case series design. -
Sulfonylureas
Therapeutic Class Overview Sulfonylureas INTRODUCTION In the United States (US), diabetes mellitus affects more than 30 million people and is the 7th leading cause of death (Centers for Disease Control and Prevention [CDC] 2018). Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is characterized by elevated fasting and postprandial glucose concentrations (American Diabetes Association [ADA] 2019[a]). It is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications (ADA 2019[b]). ○ Complications of T2DM include hypertension, heart disease, stroke, vision loss, nephropathy, and neuropathy (ADA 2019[a]). In addition to dietary and lifestyle management, T2DM can be treated with insulin, one or more oral medications, or a combination of both. Many patients with T2DM will require combination therapy (Garber et al 2019). Classes of oral medications for the management of blood glucose levels in patients with T2DM focus on increasing insulin secretion, increasing insulin responsiveness, or both, decreasing the rate of carbohydrate absorption, decreasing the rate of hepatic glucose production, decreasing the rate of glucagon secretion, and blocking glucose reabsorption by the kidney (Garber et al 2019). Pharmacologic options for T2DM include sulfonylureas (SFUs), biguanides, thiazolidinediones (TZDs), meglitinides, alpha-glucosidase inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogs, amylinomimetics, sodium-glucose cotransporter 2 (SGLT2) inhibitors, combination products, and insulin (Garber et al 2019). SFUs are the oldest of the oral antidiabetic medications, and all agents are available generically. The SFUs can be divided into 2 categories: first-generation and second-generation. -
New Therapeutic Agents Marketed in 2014: Part 1 Daniel A
CPE New therapeutic agents marketed in 2014: Part 1 Daniel A. Hussar Objective: To provide information regarding the most important properties of Daniel A. Hussar, PhD, is Remington Professor of Pharmacy, Philadelphia College new therapeutic agents that have been marketed in 2014. of Pharmacy, University of the Sciences in Data sources: Product labeling supplemented selectively with published studies Philadelphia. and drug information reference sources. Development: This home-study CPE activity Data synthesis: Seven new therapeutic agents that were marketed in the United was developed by the American Pharmacists States in early 2014 are considered in this first of a four-part series: umeclidinium Association. bromide/vilanterol trifenatate, perampanel, eslicarbazepine acetate, apremilast, dapagliflozin propanediol, avanafil, and bazedoxifene/conjugated estrogens. In- dications and information on dosage and administration for these agents are re- viewed, as are the most important pharmacokinetic properties, drug interactions, and other precautions. Practical considerations for use of these new agents are also discussed. When possible, properties of the new drugs are compared with those of older agents marketed for the same indications. Conclusion: Umeclidinium/vilanterol is the first combination formulation for oral inhalation to include both a long-acting muscarinic antagonist and a long-acting beta-2-adrenergic agonist for the maintenance treatment of patients with chronic ob- structive pulmonary disease. Both perampanel and eslicarbazepine have been ap- proved as adjunctive treatment for patients with partial-onset seizures. Perampanel has a unique mechanism of action whereas eslicarbazepine has properties that are most similar to those of oxcarbazepine. Apremilast is indicated for the treatment of patients with active psoriatic arthritis and is effective following oral administra- tion. -
Ambetter 90-Day-Maintenance Drug List- 2020
Ambetter 90-Day-Maintenance Drug List Guide to this list: What is Ambetter 90‐Day‐Maintenance Drug List? Ambetter 90‐Day‐Supply Maintenance Drug List is a list of maintenance medications that are available for 90 day supply through mail order or through our Extended Day Supply Network. How do I find a pharmacy that is participating in Extended Day Supply Network? To find a retail pharmacy that is participating in our Extended Day Supply Network please consult information available under Pharmacy Resources tab on our webpage. Alternatively, you can utilize our mail order pharmacy. Information on mail order pharmacy is available in Pharmacy Resources tab on our webpage. Are all formulary drugs covered for 90 day supply? No, certain specialty and non‐specialty drugs are excluded from 90 day supply. Please consult 90‐Day‐ Supply Maintenance Drug List for information if your drug is included. A Amitriptyline HCl Acamprosate Calcium Amlodipine Besylate Acarbose Amlodipine Besylate-Atorvastatin Calcium Acebutolol HCl Amlodipine Besylate-Benazepril HCl Acetazolamide Amlodipine Besylate-Olmesartan Medoxomil Albuterol Sulfate Amlodipine Besylate-Valsartan Alendronate Sodium Amlodipine-Valsartan-Hydrochlorothiazide Alendronate Sodium-Cholecalciferol Amoxapine Alfuzosin HCl Amphetamine-Dextroamphetamine Aliskiren Fumarate Anagrelide HCl Allopurinol Anastrozole Alogliptin Benzoate Apixaban Alosetron HCl Arformoterol Tartrate Amantadine HCl Aripiprazole Amiloride & Hydrochlorothiazide Armodafinil Amiloride HCl Asenapine Maleate Amiodarone HCl Aspirin-Dipyridamole -
Migraine Headache Prophylaxis Hien Ha, Pharmd, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas
Migraine Headache Prophylaxis Hien Ha, PharmD, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication- overuse headaches. Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. First-line med- ications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. Medications such as ami- triptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. There is limited evidence for nebivolol, bisoprolol, pindolol, carbamazepine, gabapentin, fluoxetine, nicardipine, verapamil, nimodipine, nifedipine, lisinopril, and candesartan. Acebutolol, oxcarbazepine, lamotrigine, and telmisartan are ineffective. Newer agents target calcitonin gene-related peptide pain transmission in the migraine pain pathway and have recently received approval from the U.S. Food and Drug Administration; how- ever, more studies of long-term effectiveness and adverse effects are needed. The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention. (Am Fam Physician. 2019; 99(1):17-24. -
Original Article Comparison of Therapeutic Effects of Two Ccbs on Glaucoma and Analysis of Their Possible Mechanisms
Int J Clin Exp Med 2017;10(7):10560-10564 www.ijcem.com /ISSN:1940-5901/IJCEM0056272 Original Article Comparison of therapeutic effects of two CCBs on glaucoma and analysis of their possible mechanisms Tao Liang, Lingyun Zhang, Yanhua Gao, Yanru Xiang, Yan Gao Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China Received April 26, 2017; Accepted May 26, 2017; Epub July 15, 2017; Published July 30, 2017 Abstract: Objective: To respectively compare the therapeutic effects of nimodipine and nifedipine on glaucoma, and then analyze the possible protective effects of these two calcium channel blockers (CCBs) on glaucomatous retinal ganglion cells (RGCs). Methods: Fifty-four patients with glaucoma were divided into control group (n=15), treat- ment group 1 (n=20) and treatment group 2 (n=19) in accordance with a random number table. General clinical treatment of glaucoma was performed in all three groups, while nimodipine was applied in treatment group 1 and nifedipine was applied in treatment group 2. The therapeutic effects and incidence of adverse reactions (intraocular pressure (IOP), eyesight, retinal light sensitivity, progressive visual field damage and adverse drug reaction) were compared among the three groups. Results: There were no significant differences in IOP and eyesight before and after treatment among the three groups (P>0.05). The retinal light sensitivity in control group began to decline from the sixth month after treatment, which was significantly different from treatment group 1 and treatment group 2 (P=0.03; P=0.04). The survival curve of visual field damage indicated that the visual field damage in control group was obviously more serious than that in the two treatment groups with the increase of sick time (P=0.03). -
Cyproheptadine Versus Propranolol in the Prevention of Migraine
Original Article Cyproheptadine versus propranolol in the prevention of migraine headaches in children Bahador Asadi1, Fariborz Khorvash2, Abolfazl Najaran3, Farzin Khorvash4 ABSTRACT Objective: There are conflicting results on the efficacy of propranolol and cyproheptadine in the prevention of migraine headaches in children. Therefore, in this study, we evaluated the efficacy of propranolol versus cyproheptadine in the prevention of migraine headaches. Methodology: This was a randomized, double-blind trial. Sixty children aged 8-15 yrs with migraine headaches were randomized to be treated with either propranolol (40-80mg per day) or cyproheptadine (8-12mg per day) for 4 weeks. The patients were requested to record the severity and duration of their headaches during a 2-week period before starting the intervention. The patients were followed at 2-week intervals for a period of 1 month after starting treatment. The headache diary was analyzed for each patient and was compared with baseline using SPSS software and statistical tests including the student’s t-test. Results: Out of 60 patients at baseline, nine patients in the cyproheptadine group and six patients in the propranolol group did not appear at the appropriate time for follow-up visits and therefore were excluded from the study. The mean age in the cyproheptadine group was 11.9 ± 2.23 years and in the propranolol group was 10.7 ± 2.33 years. Based on the diaries, the results showed that propranolol and cyproheptadine decreased headaches by 54.61% and 70.53% (p < 0.05), respectively, at the end of four weeks of treatment. Conclusion: Overall, the results of our study suggest that cyproheptadine is a good choice for prevention of migraine headache in pediatric group although more prolonged study with higher number of the patient is recommended. -
Glucotrol XL (Glipizide) Tablets Label
® GLUCOTROL XL (glipizide) Extended Release Tablets For Oral Use DESCRIPTION Glipizide is an oral blood-glucose-lowering drug of the sulfonylurea class. The Chemical Abstracts name of glipizide is 1-cyclohexyl-3-[[p-[2-(5 methylpyrazinecarboxamido)ethyl] phenyl]sulfonyl]urea. The molecular formula is C21H27N5O4S; the molecular weight is 445.55; the structural formula is shown below: N H C 3 CONHCH CH SO NHCONH 2 2 2 N Glipizide is a whitish, odorless powder with a pKa of 5.9. It is insoluble in water and alcohols, but soluble in 0.1 N NaOH; it is freely soluble in dimethylformamide. GLUCOTROL XL® is a registered trademark for glipizide GITS. Glipizide GITS (Gastrointestinal Therapeutic System) is formulated as a once-a-day controlled release tablet for oral use and is designed to deliver 2.5, 5, or 10 mg of glipizide. Inert ingredients in the 2.5 mg, 5 mg and 10 mg formulations are: polyethylene oxide, hypromellose, magnesium stearate, sodium chloride, red ferric oxide, cellulose acetate, polyethylene glycol, Opadry® blue (OY-LS-20921)(2.5 mg tablets), Opadry® white (YS-2-7063)(5 mg and 10 mg tablet) and black ink (S-1-8106). System Components and Performance GLUCOTROL XL Extended Release Tablet is similar in appearance to a conventional tablet. It consists, however, of an osmotically active drug core surrounded by a semipermeable membrane. The core itself is divided into two layers: an “active” layer containing the drug, and a “push” layer containing pharmacologically inert (but osmotically active) components. The membrane surrounding the tablet is permeable to water but not to drug or osmotic excipients.