DOCSLIB.ORG

0830 Hatfield.Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Masculinizing Options Swedish Hospital LGBTQ Symposium 4/13/2018 Kevin Hatfield MD The Polyclinic - Seattle WA 1 Laith Ashley Benjamin Melzer Gena Rocero 2 GOALS & OBJECTIVES Getting Started with patients Introduction, First visits and discussion points Medications to consider Androgens 5a-reductase Inhibitors, Aromatase Inhibitors Estrogen SERMS (selective estrogen receptor modulators) Progestin-only contraceptives PrEP (Pre Exposure Prophylaxis against HIV) Cases 3 Getting Started Meet the patient, Clarify Name, Pronouns, Gender Terminology Take full histories – Past and Current Medical, Surgical, Psychosocial, Sexual, Family, Medications Physical Exam “Tell me about your gender journey?” When did you first feel your gender was different than how others labeled you? When did you first discover a name for what you were experiencing? Where are you now in the process? What terms feel comfortable to describe your gender? What are your goals for today? Are you working with a skilled therapist? Patient role – “Captain of your own ship.”- Captain Kirk My Role – “safety monitor - fixer,” - Scotty 4 Approach to Masculinization What to Choose? Cross Hormone Protocol? Testosterones Aromatase inhibitors 5a-reductase inhibitors Estrogens Progestins 5 • Anastrazole (Arimidex) • Letrozole (Femara) • Finasteride (Proscar) • Exemastane • Dutasteride (Avodart) (Aromasin) 6 7 8 • Anastrazole (Arimidex) • Letrozole (Femara) • Finasteride (Proscar) • Exemastane • Dutasteride (Avodart) (Aromasin) 9 Timeline for Medicines Medicine When to Start Timeline Notes Testosterone (T) Immediately Every 3-6 months Acne, Weight gain, Mood changes Aromatase inhibitors If ongoing menses/ Titrate to effect 0.5 mg BIW/TIW? High E with slow D 5-a Reductase If androgenic alopecia Set by patient Reduced phallus inhibitor is notable, growth Contraceptives ASAP if penetration by Set by patient Choose non-hormonal sex partner with penis or progestin only method Estrogen (E) Excessive dryness/skin Set by patient Therapy discussion weakness/coital with patient, go over topicals/orals spotting options. ASAP if sexual activity Set by patient, based Q3 month BMP, HIV, RPR, increases risk of HIV on personal risk Oral/Front & Back Hole PrEP* GC/CT-NAAT if exposure. activities applicable * Pre Exposure Prophylaxis Against HIV exposure 10 Testosterone Options Oral – Striant BID adhesive trans-buccal tabs Topical - Patch and Gel – Androgel, Testoderm, Testim, Axiron etc Topical compounds – Customized - creams, ointments, gels Injectable Testosterone - Enanthate, Cypionate, Undecanoate Implantable – Testopel Topical – (Europe only) - Andractim gel (DHT) 11 Testosterone Promotes Drop in vocal pitch Cartilage thickening Frontalis muscle hypertrophy Change in body odor Amenorrhea within first 3-6 months Acne – face and back Muscle development: encourage routine exercise & stretching Increased appetite/weight gain Increase in body hair Facial hair – often much later Scalp hair loss and balding Clitoromegaly Increased libido Mood changes: Irritability is possible BUT most feel Contentment Lab changes: Hct, lipids, sCr, AlkPhos 12 Testosterone Options “T” Type Low Usual Dose Max Cost Dosing Notes Transbuccal 15 mg BID 30 mg BID 60 mg BID >$650/m BID Buccal adhesive Patch 1-2 mg 4 mg 8 mg >$530/m Daily Peel-off, linty halo Gel 1% or 1.62% 12.5 mg 50 mg 100 mg >$120/m Daily Pump or packet Transfer to partner? 2% Axillary Gel 30 mg 60 mg 120 mg $600/m Daily Messy/Sticky Custom Cream 2.5 % 5 % 20% $15-$80/m Daily Specialty Pharmacy (vehicle matters!!!) Cypionate or 20 mg 60 mg 200 mg $5-$20/ Weekly Home SQ Injection Enanthate SQ month Undecanoate 750 mg 750 mg 750 mg $800/10w Q10 Weeks One size fits all IM Injection OFFICE ONLY - IM injection Testo/Stearic 75 mg 375 mg 1125 mg $800-$1200 Q3-4 Office ONLY- Trochar acid pellets /3-4months Months Assisted Insertion 13 Testosterone ½ Life by Type Bio Enanthate Cypionate Undecanoate Type of Half-Life Dose LFT Cancer Risk Lab / Mood Testosterone Frequency D Changes Bio-identical 4-6 hours N/A Rare NOT Observed N/A Enanthate 4.5 days Q7 Days Rare NOT Observed Likely/Possible Cypionate 8 days Q7 Days Rare NOT Observed Likely/Possible Undecanoate 20 days Q70 Days Rare NOT Observed Likely/Possible 14 Testosterone Level by Decade 15 Timeline of Testosterone Changes Site of Change Time of Onset Completion Time Reversible? Skin Oiliness/Acne 1-6 months 1-2 years YES Voice Deepening 2-4 months 1-2 years NO Facial Hair/Body Hair 3-6 months 3-5 years NO Muscle Mass Increase 6-12 months 2-5 years YES Amenorrhea 2-6 months N/A YES Fat Redistribution 3-6 months 2-5 years YES Libido Increase 1-3 months 1-2 years YES Vaginal Atrophy/Dryness 3-6 months 1-2 years YES Clitoral Enlargement 3-6 months 1-2 years NO Androgenic Alopecia 6-12 months 3-5 years NO Fertility Reduction 3-6 months N/A PROBABLY 16 Other Medication Half Life (Consider Flexible Dosing) Medication / Half-Life Dose/ Cash Cost Purpose Action strength Frequency #90 tablets Finasteride 5-7 hours 1 - 2.5 mg $14-$20 Prevent 5a-Reductase 1 mg, 5 mg Daily Alopecia Inhibitor tab (Block DHT) Dutasteride 28 days 0.5 mg $35 Prevent 5a-Reductase 0.5 mg cap Daily - Alopecia Inhibitor Weekly (Block DHT) Anastrazole 2 days 0.5 mg TIW $21 Lower E2 if Blocks T 1 mg tab too high conversion to E Letrozole 2 days Daily $22 Lower E2 if Blocks T 2.5 mg tab too high conversion to E Exemestane 1 day Daily $350 Lower E2 if Blocks T 25 mg tab too high conversion to E 17 Other Medications ( for particular needs ) Medication / Half-Life Dose/ Cash Cost Purpose Action strength Frequency #90 tablets Prasterone / 38 minutes 6.5 mg $540 Reduces Local conversion DHEA 6.5 mg (DHEAS 15 Inserted Daily dryness / into Estrogens/ insert hours) fragility Androgens Ospemifene 26 hours 60 mg daily $620 Reduces SERM acivity on 60 mg oral tab dryness / mucosal tissue fragility Estrogen ring n/a 2 mg Q 90 days $450 Reduces Local release of 2 mg insert dryness / Estrogen to fragility mucosa Etonorgestrel n/a 1 implant Q 3 $900 Contraception Prevents 68 mg implant years Ovulation IUD options n/a Q 3 or more $900+ Contraception Prevents progestin/Cu years Conception 18 Testosterone Induced Lab Value and Risk Changes Probability Observation / Possible Risks Likely Increase of these Lab Values Higher LDL & Triglycerides (Lower HDL) Hematocrit Creatinine Alkaline Phosphatase Possible Increased Risk Polycythemia (Sleep Apnea induced Hypoxemia) Possible Increased Risk if Other Heart Disease Factors Present Type 2 Diabetes (weight gain) No increase Breast/Uterine/Ovarian Cancer 19 20 Typical SQ Testosterone Injection Supplies Testosterone Cypionate 200mg/ml 10 ml vial $45 3-5 month supply 18G 21G 1mL Slip Tip Luer-Lok Syringe 25G 30G 21 Testosterone Dosing and Escalation Treat Patient NOT Protocol Use patient’s age & desired rate of change Consider body habitus and menstrual regularity/dysphoria Start with 20-60 mg SQ weekly (0.1 mL – 0.3 mL of 200mg/mL T Cypionate) Check Total Testosterone and Estradiol at nadir in 5-6+ weeks Look for T nadir between 450-650 and Estradiol <50 IF T <650 consider increase by 20 mg and recheck T in 3-6 months Maintain high range T nadir for 3-5 years to complete changes If Estradiol >60 AND Pelvic complaints, ongoing menses or slow observed changes add 0.5 mg Anastrazole BIW-TIW and look for Estradiol to fall back to normal male range 22 Remember to discuss Sexually Transmitted Infections Some patients may ask about precautions but … Please be proactive – inform and educate, offer 3 site testing “An ounce of prevention…” My mantra – “Leave no ‘active’ orifice untested!” 23 Case 1 - Martin - February 2017 Martin, 18 yo AFAB headed to WSU in Fall. “100% guy” ; he/him pronouns. “I have known since 3rd grade.” Medical history; Vaccine Hx, Surg Hx. Social history – “parents not on board” Working part time for college money (-)Tobacco, (+)THC, (+)Dating No prior HPV vaccine (#1 today) Dates only vagina-bodied people Would like to get a counselor Binder is effective but rigidly inelastic Baseline labs Total T 39 ng/dL, E 215 pg/mL, HCT 35.6% What can we do for him? 24 Martin – April 2017 ; 2 month follow up/lab visit Prior labs T 39 ng/dL E 215 pg/mL Nadir labs prior to visit Total T 270, E 142, HCT 37 HCT 35.6% Medication started – decided to pay cash, ongoing counseling to improve parental relationship Needle phobia is improving (great! HPV#2 today!) Noting some changes from T New binder is “ok, but not great” Dating life is “busier”, Still using THC – “but less than before” Wants Male gender in EPIC & Driver License form Surgical consult information (top surgery) 25 Martin – August 2017, 4 month follow up/lab visit Prior Labs T 270 Nadir Labs done a week prior to visit E 142 Total Testosterone 490, Estradiol 46, HCT 45.6 HCT 37% Physical exam Voice deeper Facial hair Acne – manageable No bleeding for 7 weeks – “very happy” Sexual activity – “Still dating and doing fine” Joint counseling sessions with parents went well! Wants all legal gender forms prior to college (in 2 weeks) HPV #3 today Outline next visits during college breaks Then you get Email in November 2017 about changes in his dating life… 26 Case #2 – Max - July 2016 32 yo Max has known about personal gender nonconformity since gradeschool. Came out to parents & friends as Bisexual in 9th grade. Parent’s voiced “concerns about sexuality” Married to cis-female partner, has 2 yo child. Gender talk with spouse earlier this year – “Went pretty well” They/them pronouns; Identifies as “Non-binary - Transmasculine” PMHx : Obesity, Asthma, Elevated Triglycerides SurgHx : C-section FamHx: Dad HTN, OSA; Mom Obesity, DM2 @44; Brother OSA SocHx: Moved to Seattle 2 months ago from Ames Iowa; Works at Big tech company with wife; 7-10 drinks per week, (-) Tobacco, (-) THC, Committed non-monogamous.
Recommended publications
  • Presence and Metabolism of Endogenous Androgenic–Anabolic Steroid Hormones in Meat-Producing Animals: a Review J

    Presence and Metabolism of Endogenous Androgenic–Anabolic Steroid Hormones in Meat-Producing Animals: a Review J

    Food Additives and Contaminants Vol. 26, No. 5, May 2009, 640–671 Presence and metabolism of endogenous androgenic–anabolic steroid hormones in meat-producing animals: a review J. Scartha*, C. Akreb, L. van Ginkelc, B. Le Bizecd, H. De Brabandere, W. Korthf, J. Pointsg, P. Tealea and J. Kayh aHFL Sport Science (a Quotient Bioresearch Company), Fordham, UK; bCanadian Food Inspection Agency, Saskatoon, Canada; cNational Institute of Public Health and the Environment, RIVM, European Union Community Reference Laboratory for Residues, Bilthoven, the Netherlands; dLABERCA, Ecole Nationale Ve´te´rinaire de Nantes, Nantes, France; eFaculty of Veterinary Medicine, Laboratory of Chemical Analysis, Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium; fNational Residue Survey, Australian Government Department of Agriculture, Fisheries and Forestry, Barton, ACT, Australia; gVeterinary Drugs Group, LGC, Teddington, UK; hVeterinary Medicines Directorate, Addlestone, UK (Received 17 April 2008; final version received 15 November 2008) The presence and metabolism of endogenous steroid hormones in meat-producing animals has been the subject of much research over the past 40 years. While significant data are available, no comprehensive review has yet been performed. Species considered in this review are bovine, porcine, ovine, equine, caprine and cervine, while steroid hormones include the androgenic–anabolic steroids testosterone, nandrolone and boldenone, as well as their precursors and metabolites. Information on endogenous steroid hormone concentrations is primarily useful in two ways: (1) in relation to pathological versus ‘normal’ physiology and (2) in relation to the detection of the illegal abuse of these hormones in residue surveillance programmes. Since the major focus of this review is on the detection of steroids abuse in animal production, the information gathered to date is used to guide future research.
  • Jp Xvii the Japanese Pharmacopoeia

    Jp Xvii the Japanese Pharmacopoeia

    JP XVII THE JAPANESE PHARMACOPOEIA SEVENTEENTH EDITION Official from April 1, 2016 English Version THE MINISTRY OF HEALTH, LABOUR AND WELFARE Notice: This English Version of the Japanese Pharmacopoeia is published for the convenience of users unfamiliar with the Japanese language. When and if any discrepancy arises between the Japanese original and its English translation, the former is authentic. The Ministry of Health, Labour and Welfare Ministerial Notification No. 64 Pursuant to Paragraph 1, Article 41 of the Law on Securing Quality, Efficacy and Safety of Products including Pharmaceuticals and Medical Devices (Law No. 145, 1960), the Japanese Pharmacopoeia (Ministerial Notification No. 65, 2011), which has been established as follows*, shall be applied on April 1, 2016. However, in the case of drugs which are listed in the Pharmacopoeia (hereinafter referred to as ``previ- ous Pharmacopoeia'') [limited to those listed in the Japanese Pharmacopoeia whose standards are changed in accordance with this notification (hereinafter referred to as ``new Pharmacopoeia'')] and have been approved as of April 1, 2016 as prescribed under Paragraph 1, Article 14 of the same law [including drugs the Minister of Health, Labour and Welfare specifies (the Ministry of Health and Welfare Ministerial Notification No. 104, 1994) as of March 31, 2016 as those exempted from marketing approval pursuant to Paragraph 1, Article 14 of the Same Law (hereinafter referred to as ``drugs exempted from approval'')], the Name and Standards established in the previous Pharmacopoeia (limited to part of the Name and Standards for the drugs concerned) may be accepted to conform to the Name and Standards established in the new Pharmacopoeia before and on September 30, 2017.
  • (12) Patent Application Publication (10) Pub. No.: US 2011/0159073 A1 De Juan Et Al

    (12) Patent Application Publication (10) Pub. No.: US 2011/0159073 A1 De Juan Et Al

    US 20110159073A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2011/0159073 A1 de Juan et al. (43) Pub. Date: Jun. 30, 2011 (54) METHODS AND DEVICES FOR THE Publication Classification TREATMENT OF OCULAR CONDITIONS (51) Int. Cl. (76) Inventors: Eugene de Juan, LaCanada, CA A6F 2/00 (2006.01) (US); Signe E. Varner, Los (52) U.S. Cl. ........................................................ 424/427 Angeles, CA (US); Laurie R. Lawin, New Brighton, MN (US) (57) ABSTRACT Featured is a method for instilling one or more bioactive (21) Appl. No.: 12/981,038 agents into ocular tissue within an eye of a patient for the treatment of an ocular condition, the method comprising con (22) Filed: Dec. 29, 2010 currently using at least two of the following bioactive agent delivery methods (A)-(C): (A) implanting a Sustained release Related U.S. Application Data delivery device comprising one or more bioactive agents in a (63) Continuation of application No. 1 1/175,850, filed on posterior region of the eye so that it delivers the one or more Jul. 5, 2005, now abandoned. bioactive agents into the vitreous humor of the eye; (B) instill ing (e.g., injecting or implanting) one or more bioactive (60) Provisional application No. 60/585,236, filed on Jul. 2, agents Subretinally; and (C) instilling (e.g., injecting or deliv 2004, provisional application No. 60/669,701, filed on ering by ocular iontophoresis) one or more bioactive agents Apr. 8, 2005. into the vitreous humor of the eye. Patent Application Publication Jun. 30, 2011 Sheet 1 of 22 US 2011/O159073 A1 Patent Application Publication Jun.
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued

    Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued

    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
  • Bulk Drug Substances Nominated for Use in Compounding Under Section 503B of the Federal Food, Drug, and Cosmetic Act

    Bulk Drug Substances Nominated for Use in Compounding Under Section 503B of the Federal Food, Drug, and Cosmetic Act

    Updated June 07, 2021 Bulk Drug Substances Nominated for Use in Compounding Under Section 503B of the Federal Food, Drug, and Cosmetic Act Three categories of bulk drug substances: • Category 1: Bulk Drug Substances Under Evaluation • Category 2: Bulk Drug Substances that Raise Significant Safety Risks • Category 3: Bulk Drug Substances Nominated Without Adequate Support Updates to Categories of Substances Nominated for the 503B Bulk Drug Substances List1 • Add the following entry to category 2 due to serious safety concerns of mutagenicity, cytotoxicity, and possible carcinogenicity when quinacrine hydrochloride is used for intrauterine administration for non- surgical female sterilization: 2,3 o Quinacrine Hydrochloride for intrauterine administration • Revision to category 1 for clarity: o Modify the entry for “Quinacrine Hydrochloride” to “Quinacrine Hydrochloride (except for intrauterine administration).” • Revision to category 1 to correct a substance name error: o Correct the error in the substance name “DHEA (dehydroepiandosterone)” to “DHEA (dehydroepiandrosterone).” 1 For the purposes of the substance names in the categories, hydrated forms of the substance are included in the scope of the substance name. 2 Quinacrine HCl was previously reviewed in 2016 as part of FDA’s consideration of this bulk drug substance for inclusion on the 503A Bulks List. As part of this review, the Division of Bone, Reproductive and Urologic Products (DBRUP), now the Division of Urology, Obstetrics and Gynecology (DUOG), evaluated the nomination of quinacrine for intrauterine administration for non-surgical female sterilization and recommended that quinacrine should not be included on the 503A Bulks List for this use. This recommendation was based on the lack of information on efficacy comparable to other available methods of female sterilization and serious safety concerns of mutagenicity, cytotoxicity and possible carcinogenicity in use of quinacrine for this indication and route of administration.
  • Application No. AU 2019203067 A1 AUSTRALIAN PATENT OFFICE

    Application No. AU 2019203067 A1 AUSTRALIAN PATENT OFFICE

    (12) STANDARD PATENT APPLICATION (11) Application No. AU 2019203067 A1 (19) AUSTRALIAN PATENT OFFICE (54) Title CONTROLLED RELEASE NASAL TESTOSTERONE GELS, METHODS AND PRE­ FILLED MULTI-DOSE APPLICATOR SYSTEMS FOR PERNASAL ADMINISTRATION (51) International Patent Classification(s) A61K9/00 (2006.01) A61K 47/34 (2006.01) A61K9/06 (2006.01) A61K 47/44 (2006.01) A61K 31/568 (2006.01) A61P 5/26 (2006.01) (21) Application No: 2019203067 (22) Date of Filing: 2019.04.30 (43) Publication Date: 2019.05.23 (43) Publication Journal Date: 2019.05.23 (62) Divisional of: 2017204182 (71) Applicant(s) Acerus Pharmaceuticals SRL (72) Inventor(s) Kreppner, Wayne;Fogarty, Siobban;Oberegger, Werner;Maes, Paul Jose Pierre Marie (74) Agent / Attorney Pizzeys Patent and Trade Mark Attorneys Pty Ltd, GPO Box 1374, BRISBANE, QLD, 4001, AU ABSTRACT The present invention relates to intranasal testosterone gels for the controlled release of testosterone into the systemic circulation of males and females for providing constant effective testosterone blood levels, without inducing undesired testosterone spike in blood levels, following pernasal administration. The intranasal testosterone gels of the present invention are safe, convenient to use, well tolerated, stable and easily and reproducibly manufactured on scale up. Moreover, because supra- normal and sub-normal testosterone blood levels are believed to be essentially kept to a minimum or avoided and the testosterone serum levels are believed to remain essentially constant during dose life, i.e., the intranasal
  • CHAPTER I: INTRODUCTION Use of Steroids in Sports Such

    CHAPTER I: INTRODUCTION Use of Steroids in Sports Such

    CHAPTER I: INTRODUCTION The drugs are artificially derived from the main male hormone Testosterone. Testosterone is important for promoting and maintaining muscle growth and developing secondary male sex characteristics, such as a deepening voice and facial hair. Anabolic steroids, also called Anabolic-Androgenic Steroids (AASs), can build muscle and improve athletic performance, but they can also have significant adverse effects, especially when used incorrectly. Long-term, non-medical uses are linked to heart problems, unwanted physical changes, and aggression. There is growing concern worldwide about the non- medical use of steroids and its effects. Street names include Arnolds, gym candy, pumpers, roids, and stackers. AASs are synthetic versions of the primary male hormone, testosterone. They affect many parts of the body, including the muscles, bones, hair follicles, liver, kidneys, blood, immune system, reproductive system and the central nervous system. During puberty, increases in testosterone levels enable the development of characteristics such as facial and body hair growth, increased height and muscle mass, a deepening voice, and the sex drive. Testosterone can also contribute to competitiveness, self-esteem, and aggressiveness. Continuous use of AASs can lead to problems such as tolerance. They may even cause the body to stop producing its own testosterone. Some people use AASs continuously, but others try to minimize their possible adverse effects through different patterns of use. Use of Steroids In Sports Such As: 1. Cycling: The person takes AASs in cycles of 6 to 12 weeks known as the "on" period, followed by 4 weeks to several months off. 2. Stacking: Users combine several different types of steroids or incorporate other supplements in an attempt to maximize the effectiveness of the steroids.
  • Appendix B - Product Name Sorted by Applicant

    Appendix B - Product Name Sorted by Applicant

    JUNE 2021 - APPROVED DRUG PRODUCT LIST B - 1 APPENDIX B - PRODUCT NAME SORTED BY APPLICANT ** 3 ** 3D IMAGING DRUG * 3D IMAGING DRUG DESIGN AND DEVELOPMENT LLC AMMONIA N 13, AMMONIA N-13 FLUDEOXYGLUCOSE F18, FLUDEOXYGLUCOSE F-18 SODIUM FLUORIDE F-18, SODIUM FLUORIDE F-18 3M * 3M CO PERIDEX, CHLORHEXIDINE GLUCONATE * 3M HEALTH CARE INC AVAGARD, ALCOHOL (OTC) DURAPREP, IODINE POVACRYLEX (OTC) 3M HEALTH CARE * 3M HEALTH CARE INFECTION PREVENTION DIV SOLUPREP, CHLORHEXIDINE GLUCONATE (OTC) ** 6 ** 60 DEGREES PHARMS * 60 DEGREES PHARMACEUTICALS LLC ARAKODA, TAFENOQUINE SUCCINATE ** A ** AAA USA INC * ADVANCED ACCELERATOR APPLICATIONS USA INC LUTATHERA, LUTETIUM DOTATATE LU-177 NETSPOT, GALLIUM DOTATATE GA-68 AAIPHARMA LLC * AAIPHARMA LLC AZASAN, AZATHIOPRINE ABBVIE * ABBVIE INC ANDROGEL, TESTOSTERONE CYCLOSPORINE, CYCLOSPORINE DEPAKOTE ER, DIVALPROEX SODIUM DEPAKOTE, DIVALPROEX SODIUM GENGRAF, CYCLOSPORINE K-TAB, POTASSIUM CHLORIDE KALETRA, LOPINAVIR NIASPAN, NIACIN NIMBEX PRESERVATIVE FREE, CISATRACURIUM BESYLATE NIMBEX, CISATRACURIUM BESYLATE NORVIR, RITONAVIR SYNTHROID, LEVOTHYROXINE SODIUM ** TARKA, TRANDOLAPRIL TRICOR, FENOFIBRATE TRILIPIX, CHOLINE FENOFIBRATE ULTANE, SEVOFLURANE ZEMPLAR, PARICALCITOL ABBVIE ENDOCRINE * ABBVIE ENDOCRINE INC LUPANETA PACK, LEUPROLIDE ACETATE ABBVIE ENDOCRINE INC * ABBVIE ENDOCRINE INC LUPRON DEPOT, LEUPROLIDE ACETATE LUPRON DEPOT-PED KIT, LEUPROLIDE ACETATE ABBVIE INC * ABBVIE INC DUOPA, CARBIDOPA MAVYRET, GLECAPREVIR NORVIR, RITONAVIR ORIAHNN (COPACKAGED), ELAGOLIX SODIUM,ESTRADIOL,NORETHINDRONE ACETATE
  • Customs Tariff - Schedule

    Customs Tariff - Schedule

    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2020 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, following to be employed in commercial fishing or the commercial UST, MXT, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.
  • (12) Patent Application Publication (10) Pub. No.: US 2004/0058896 A1 Dietrich Et Al

    (12) Patent Application Publication (10) Pub. No.: US 2004/0058896 A1 Dietrich Et Al

    US 200400.58896A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2004/0058896 A1 Dietrich et al. (43) Pub. Date: Mar. 25, 2004 (54) PHARMACEUTICAL PREPARATION (30) Foreign Application Priority Data COMPRISING AN ACTIVE DISPERSED ON A MATRIX Dec. 7, 2000 (EP)........................................ OO126847.3 (76) Inventors: Rango Dietrich, Konstanz (DE); Publication Classification Rudolf Linder, Kontanz (DE); Hartmut Ney, Konstanz (DE) (51) Int. Cl." ...................... A61K 31156; A61K 31/4439 (52) U.S. Cl. ........................... 514/171; 514/179; 514/338 Correspondence Address: (57) ABSTRACT NATH & ASSOCATES PLLC 1030 FIFTEENTH STREET, N.W. The present invention relates to the field of pharmaceutical SIXTH FLOOR technology and describes a novel advantageous preparation WASHINGTON, DC 20005 (US) for an active ingredient. The novel preparation is Suitable for 9 producing a large number of pharmaceutical dosage forms. (21) Appl. No.: 10/433,398 In the new preparation an active ingredient is present essentially uniformly dispersed in an excipient matrix com (22) PCT Filed: Dec. 6, 2001 posed of one or more excipients Selected from the group of fatty alcohol, triglyceride, partial glyceride and fatty acid (86) PCT No.: PCT/EPO1/14307 eSter. US 2004/0058896 A1 Mar. 25, 2004 PHARMACEUTICAL PREPARATION 0008 Further subject matters are evident from the claims. COMPRISING AN ACTIVE DISPERSED ON A MATRIX 0009. The preparations for the purpose of the invention preferably comprise numerous individual units in which at least one active ingredient particle, preferably a large num TECHNICAL FIELD ber of active ingredient particles, is present in an excipient 0001. The present invention relates to the field of phar matrix composed of the excipients of the invention (also maceutical technology and describes a novel advantageous referred to as active ingredient units hereinafter).
  • Harmonized Tariff Schedule of the United States (2004) -- Supplement 1 Annotated for Statistical Reporting Purposes

    Harmonized Tariff Schedule of the United States (2004) -- Supplement 1 Annotated for Statistical Reporting Purposes

    Harmonized Tariff Schedule of the United States (2004) -- Supplement 1 Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2004) -- Supplement 1 Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 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. ABACAVIR 136470-78-5 ACEXAMIC ACID 57-08-9 ABAFUNGIN 129639-79-8 ACICLOVIR 59277-89-3 ABAMECTIN 65195-55-3 ACIFRAN 72420-38-3 ABANOQUIL 90402-40-7 ACIPIMOX 51037-30-0 ABARELIX 183552-38-7 ACITAZANOLAST 114607-46-4 ABCIXIMAB 143653-53-6 ACITEMATE 101197-99-3 ABECARNIL 111841-85-1 ACITRETIN 55079-83-9 ABIRATERONE 154229-19-3 ACIVICIN 42228-92-2 ABITESARTAN 137882-98-5 ACLANTATE 39633-62-0 ABLUKAST 96566-25-5 ACLARUBICIN 57576-44-0 ABUNIDAZOLE 91017-58-2 ACLATONIUM NAPADISILATE 55077-30-0 ACADESINE 2627-69-2 ACODAZOLE 79152-85-5 ACAMPROSATE 77337-76-9 ACONIAZIDE 13410-86-1 ACAPRAZINE 55485-20-6 ACOXATRINE 748-44-7 ACARBOSE 56180-94-0 ACREOZAST 123548-56-1 ACEBROCHOL 514-50-1 ACRIDOREX 47487-22-9 ACEBURIC ACID 26976-72-7

  • FEP 5 Tier Rx Drug Formulary (607) Standard Option

    FEP 5 Tier Rx Drug Formulary (607) Standard Option Effective July 1, 2021 The FEP formulary includes the preferred drug list which is comprised of Tier 1, generics and Tier 2, preferred brand-name drugs. Also included in the formulary are Tier 3, non-preferred brand-name drugs, Tier 4, preferred specialty drugs and Tier 5, non-preferred specialty drugs. Ask your physician if there is a generic drug available to treat your condition. If there is no generic drug available, ask your physician to prescribe a preferred brand-name drug. The preferred brand-name drugs within our formulary are listed to identify medicines that are clinically appropriate and cost-effective. Click on the category name in the Table of Contents below to go directly to that page INTRODUCTION ........................................................................................................................................................................................................................ 5 PREFACE ................................................................................................................................................................................................................................... 5 EXCLUDED DRUGS .................................................................................................................................................................................................................. 6 PRIOR APPROVAL ..................................................................................................................................................................................................................