DOCSLIB.ORG

The Diagnosis and Treatment of Lung Cancer (2005) – Including the Original Sections of the Guideline That Have Been Updated by the 2011 Document

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Diagnosis and Treatment of Lung Cancer (2005) – Including the Original Sections of the Guideline That Have Been Updated by the 2011 Document Appendix 10 Lung cancer: the diagnosis and treatment of lung cancer (2005) – including the original sections of the guideline that have been updated by the 2011 document. The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 1 of 208 Foreword Lung cancer remains the UK‘s commonest cause of cancer death. It is now over 50 years since Sir Richard Doll‘s seminal paper linked tobacco smoking to lung cancer. Although tobacco consumption has fallen overall since then, with a resultant fall in the male incidence of lung cancer, smoking has increased in women, having the effect of increased lung cancer in females. Tobacco control remains the crucial factor in reducing future lung cancer rates. It is clear to everyone involved in lung cancer care that the public concept of this disease is characterised by much negativity. There is too much emphasis generally on the relatively poor outcomes of treatment, there is a lack of sympathy for the patients deemed to have brought the disease on themselves through tobacco use, and there is an impression which is unwarranted, that some professionals have a nihilistic attitude about the treatment of lung cancer patients. There are few patient advocates, and the disease has a low public profile in respect of media coverage, general awareness and research funding. However, in reviewing the research, and preparing this guideline, the Development Group were encouraged by many positive developments such as the emergence of the lung cancer specialist nurse service, the creation of Lung Cancer Multi-Disciplinary teams, and the iprovement in the evidence base for treatment, especially chemotherapy. We would also wish to highlight developments in technology, such as FDG-PET scanning in disease staging and the use of the CHART regimen for the delivery of radical radiotherapy in suitable patients. The Development Group were charged to consider ―the diagnosis and treatment of lung cancer‖. This is a huge topic overall. To consider every nuance of presentation and management in this guideline would have been a formidable and impossible task. We have not set out to write a text book of lung cancer care. Rather, we have attempted to review the main outlines of lung cancer presentation, diagnosis and treatment, with particular emphasis on areas where there has been new evidence, or, where it seems to us, carefully evaluated guidance, which will improve patient care. It has been a difficult decision for the group as to which aspects to include, which to omit and which to highlight. It has been particularly difficult too to narrow down our original 94 recommendations to 10 key items, which we believe if implemented, will have the greatest impact on patient outcomes. We hope however that the research review in this document and the conclusions we have drawn from it will continue the improvements which are taking place in the care of patients with this common and important disease. Jesme Baird, Chair, Guideline Development Group. The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 2 of 208 Contents 1 INTRODUCTION 1 1.1 BACKGROUND 1 1.2 WHAT IS A GUIDELINE? 2 1.3 REMIT OF THE GUIDELINE 2 1.4 WHAT THE GUIDELINE COVERS 2 1.5 WHAT THE GUIDELINE DOES NOT COVER 3 1.6 COLLABORATION WITH THE SCOTTISH INTERCOLLEGIATE GUIDELINE NETWORK 3 1.7 WHO DEVELOPED THE GUIDELINE? 3 1.8 SUMMARY OF THE RECOMMENDATIONS AND THE ALGORITHM 4 2 METHODOLOGY 21 2.1 GUIDELINE METHODOLOGY 21 2.2 REVIEW OF THE CLINICAL LITERATURE 21 2.3 HIERARCHY OF CLINICAL EVIDENCE 22 2.4 HEALTH ECONOMICS METHODS 24 2.5 FORMING AND GRADING THE RECOMMENDATIONS 25 3 ACCESS TO SERVICES 27 3.1 INTRODUCTION 27 3.2 METHODOLOGY 27 3.3 PATIENT DELAY IN PRESENTATION TO GENERAL PRACTITIONERS 27 3.4 KEY SYMPTOMS AND SIGNS 28 3.5 RECOMMENDATIONS 29 4 DIAGNOSIS 31 4.1 INTRODUCTION 31 4.2 TECHNIQUES INCLUDED IN THIS REVIEW 31 4.3 METHODOLOGY 31 4.4 IMAGING 32 4.5 TISSUE CONFIRMATION 34 4.6 ECONOMICS OF DIAGNOSIS OF LUNG CANCER 38 4.7 RECOMMENDATIONS 42 5 STAGING OF LUNG CANCER 43 5.1 INTRODUCTION 43 5.2 TECHNIQUES INCLUDED IN THIS REVIEW 43 5.3 METHODOLOGY 43 5.4 STAGING CLASSIFICATIONS 43 5.5 T-STAGE ASSESSMENT 44 5.6 N-STAGE ASSESSMENT 45 5.7 M-STAGE ASSESSMENT 49 5.8 STAGING OF SMALL CELL LUNG CANCER 52 5.9 ECONOMICS OF LUNG CANCER STAGING 53 5.10 RECOMMENDATIONS 58 6 SURGERY WITH CURATIVE INTENT FOR PATIENTS WITH NON-SMALL CELL LUNG CANCER 60 6.1 INTRODUCTION 60 6.2 TECHNIQUES INCLUDED IN THIS REVIEW 60 6.3 METHODOLOGY 60 6.4 PREOPERATIVE SELECTION OF PATIENTS WITH NON SMALL CELL LUNG CANCER FOR SURGERY 60 6.5 RISK OF SURGERY 60 6.6 SURGERY FOR STAGE I NON SMALL CELL LUNG CANCER 61 6.7 SURGERY FOR STAGE II NON SMALL CELL LUNG CANCER (N1 DISEASE) 65 6.8 SURGERY FOR STAGE IIB-IIIA NON SMALL CELL LUNG CANCER (T3 DISEASE) 67 6.9 SURGERY FOR STAGE IIIA NON SMALL CELL LUNG CANCER (N2 DISEASE) 68 6.10 SURGERY FOR STAGE IIIB (N3 AND T4 DISEASE) NON SMALL CELL LUNG The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 3 of 208 CANCER 70 6.11 ECONOMICS OF SURGERY FOR NON SMALL CELL LUNG CANCER 71 6.12 RECOMMENDATIONS 72 7 RADICAL RADIOTHERAPY ALONE FOR TREATMENT OF NON-SMALL CELL LUNG CANCER 74 7.1 INTRODUCTION 74 7.2 TECHNIQUES INCLUDED IN THIS REVIEW 74 7.3 METHODOLOGY 75 7.4 ASSESSMENT OF PATIENTS FOR RADICAL RADIOTHERAPY 75 7.5 RADICAL RADIOTHERAPY FOR STAGE I AND II MEDICALLY INOPERABLE NON SMALL CELL LUNG CANCER PATIENTS 75 7.6 TREATMENT OF STAGE IIIA AND IIIB NON SMALL CELL LUNG CANCER PATIENTS 77 7.7 ECONOMICS OF RADICAL RADIOTHERAPY FOR NON SMALL CELL LUNG CANCER 80 7.8 CONCLUSION 81 7.9 RECOMMENDATIONS 82 8 CHEMOTHERAPY FOR NON SMALL CELL LUNG CANCER 83 8.1 INTRODUCTION 83 8.2 THE DRUGS INCLUDED IN THIS REVIEW 83 8.3 METHODOLOGY 83 8.4 PATIENT ELIGIBILITY 84 8.5 CHEMOTHERAPY + ACTIVE SUPPORTIVE CARE (ASC) VERSUS ASC 84 8.6 SECOND GENERATION VERSUS THIRD GENERATION REGIMENS 85 8.7 CARBOPLATIN VERSUS CISPLATIN 85 8.8 THIRD GENERATION CHEMOTHERAPY TREATMENT 85 8.9 DURATION OF THERAPY IN ADVANCED NON SMALL CELL LUNG CANCER 86 8.10 DOSAGE OF CHEMOTHERAPY TREATMENT 87 8.11 SECOND-LINE CHEMOTHERAPY IN NON SMALL CELL LUNG CANCER 87 8.12 ECONOMICS OF CHEMOTHERAPY FOR NON SMALL CELL LUNG CANCER 87 8.13 CONCLUSIONS 94 8.14 RECOMMENDATIONS 94 9 COMBINATION TREATMENT FOR NON SMALL CELL LUNG CANCER 95 9.1 INTRODUCTION 95 9.2 TECHNIQUES INCLUDED IN THIS REVIEW 96 9.3 METHODOLOGY 96 9.4 PREOPERATIVE CHEMOTHERAPY 96 9.5 POSTOPERATIVE CHEMOTHERAPY 97 9.6 PREOPERATIVE RADIOTHERAPY 98 9.7 POSTOPERATIVE RADIOTHERAPY 98 9.8 POSTOPERATIVE CHEMORADIOTHERAPY 99 9.9 PRIMARY CHEMORADIOTHERAPY FOR INOPERABLE NON SMALL CELL LUNG CANCER 99 9.10 PANCOAST TUMOURS 101 9.11 ECONOMICS OF COMBINATION TREATMENT FOR NON SMALL CELL LUNG CANCER 102 9.12 RECOMMENDATIONS 104 10 ENDOBRONCHIAL TREATMENT AS RADICAL TREATMENT FOR NON SMALL CELL LUNG CANCER 105 10.1 INTRODUCTION 105 10.2 TECHNIQUES INCLUDED IN THIS REVIEW 105 10.3 METHODOLOGY 105 10.4 PHOTODYNAMIC THERAPY 105 10.5 BRACHYTHERAPY 106 10.6 ELECTROCAUTERY 106 The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 4 of 208 10.7 CRYOTHERAPY 107 10.8 ND YAG LASER ABLATION 107 10.9 ECONOMICS OF ENDOBRONCHIAL THERAPY FOR NON SMALL CELL LUNG CANCER 107 10.10 RECOMMENDATIONS 107 11 TREATMENT OF SMALL CELL LUNG CANCER 109 11.1 INTRODUCTION 109 11.2 TREATMENT TECHNIQUES INCLUDED IN THIS REVIEW 1 09 11.3 METHODOLOGY 109 11.4 PATIENT ELIGIBILITY 109 11.5 CHEMOTHERAPY 110 11.6 RADIOTHERAPY 113 11.7 SURGERY FOR PATIENTS WITH SCLC 116 11.8 ECONOMICS OF THE TREATMENT OF SCLC 116 11.9 RECOMMENDATIONS 118 12 PALLIATIVE INTERVENTIONS AND SUPPORTIVE AND PALLIATIVE CARE 1 20 12.1 INTRODUCTION 120 12.2 TOOLS INCLUDED IN THIS REVIEW 122 12.3 METHODOLOGY 123 12.4 COMMUNICATION 123 12.5 MANAGEMENT OF DYSPNOEA (BREATHLESSNESS) 127 12.6 MANAGEMENT OF COUGH 130 12.7 MANAGEMENT OF HOARSENESS 131 12.8 CHEST PAIN 131 12.9 SUPERIOR VENA CAVA OBSTRUCTION 131 12.10 MANAGEMENT OF BRAIN METASTASES 132 12.11 SPINAL CORD COMPRESSION 133 12.12 HYPERCALCAEMIA, BONE PAIN AND PATHOLOGICAL FRACTURES 134 12.13 OTHER SYMPTOMS: WEIGHT LOSS, LOSS OF APPETITE, DIFFICULTY SWALLOWING, FATIGUE AND DEPRESSION 135 12.14 ECONOMICS OF PALLIATIVE INTERVENTIONS 136 12.15 RECOMMENDATIONS 138 13 SERVICE ORGANISATION 140 13.1 INTRODUCTION 140 13.2 ISSUES EXAMINED IN THIS REVIEW 140 13.3 METHODOLOGY 140 13.4 MULTI- DISCIPLINARY TEAMS (MDTS) 140 13.5 EARLY DIAGNOSIS CLINICS 141 13.6 SPECIALIST NURSE SUPPORT 141 13.7 TIMING OF TREATMENT 142 13.8 FOLLOW UP 143 13.9 THE PATIENT‘S PERSPECTIVE 147 13.10 RECOMMENDATIONS 149 14 PRIORITY AREAS FOR AUDIT 150 15 BIBLIOGRAPHY 153 The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 5 of 208 Stakeholder Involvement The following stakeholders registered with NICE and were invited to comment on draft versions of these guidelines: The diagnosis and treatment of lung cancer (update): full guideline (April 2011) Appendix 10 Page 6 of 208 Abbott Laboratories Limited (BASF/Knoll) College of Occupational Therapists Action on Smoking and Health (ASH) Countess of Chester Hospitals NHS Trust Afiya Trust, The Craven Harrogate & Rural District PCT Aintree Hospitals NHS Trust Department of Health Airedale General Hospital Eisai Limited Amersham Health Elan Pharmaceuticals Ltd Amgen UK Ltd Eli Lilly and Company Ltd Anglesey Local Health Board Faculty of Public Health Association for Palliative Medicine of Great Gateshead Health NHS Trust Britain and Ireland GE Health
Load more

Recommended publications
  • Update on Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis
    J Bras Pneumol. 2015;41(5):454-466 http://dx.doi.org/10.1590/S1806-37132015000000152 REVIEW ARTICLE Update on diagnosis and treatment of idiopathic pulmonary fibrosis José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6 1. Divisão de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil. 2. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, ABSTRACT Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of 3. Disciplina de Pneumologia e Tisiologia, unknown etiology, which is associated with a progressive decrease in pulmonary Faculdade de Ciências Médicas, function and with high mortality rates. Interest in and knowledge of this disorder have Universidade do Estado do Rio de grown substantially in recent years. In this review article, we broadly discuss distinct Janeiro, Rio de Janeiro, Brasil. aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We 4. Ambulatório de Pneumologia, Hospital list the current diagnostic criteria and describe the therapeutic approaches currently Ana Nery, Salvador, Brasil. available, symptomatic treatments, the action of new drugs that are effective in slowing 5. Ambulatório de Doenças Pulmonares Intersticiais, Hospital do Servidor the decline in pulmonary function, and indications for lung transplantation. Público Estadual de São Paulo, São Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Paulo, Brasil. Idiopathic pulmonary fibrosis/rehabilitation. 6. Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
    [Show full text]
  • Product List March 2019 - Page 1 of 53
    Wessex has been sourcing and supplying active substances to medicine manufacturers since its incorporation in 1994. We supply from known, trusted partners working to full cGMP and with full regulatory support. Please contact us for details of the following products. Product CAS No. ( R)-2-Methyl-CBS-oxazaborolidine 112022-83-0 (-) (1R) Menthyl Chloroformate 14602-86-9 (+)-Sotalol Hydrochloride 959-24-0 (2R)-2-[(4-Ethyl-2, 3-dioxopiperazinyl) carbonylamino]-2-phenylacetic 63422-71-9 acid (2R)-2-[(4-Ethyl-2-3-dioxopiperazinyl) carbonylamino]-2-(4- 62893-24-7 hydroxyphenyl) acetic acid (r)-(+)-α-Lipoic Acid 1200-22-2 (S)-1-(2-Chloroacetyl) pyrrolidine-2-carbonitrile 207557-35-5 1,1'-Carbonyl diimidazole 530-62-1 1,3-Cyclohexanedione 504-02-9 1-[2-amino-1-(4-methoxyphenyl) ethyl] cyclohexanol acetate 839705-03-2 1-[2-Amino-1-(4-methoxyphenyl) ethyl] cyclohexanol Hydrochloride 130198-05-9 1-[Cyano-(4-methoxyphenyl) methyl] cyclohexanol 93413-76-4 1-Chloroethyl-4-nitrophenyl carbonate 101623-69-2 2-(2-Aminothiazol-4-yl) acetic acid Hydrochloride 66659-20-9 2-(4-Nitrophenyl)ethanamine Hydrochloride 29968-78-3 2,4 Dichlorobenzyl Alcohol (2,4 DCBA) 1777-82-8 2,6-Dichlorophenol 87-65-0 2.6 Diamino Pyridine 136-40-3 2-Aminoheptane Sulfate 6411-75-2 2-Ethylhexanoyl Chloride 760-67-8 2-Ethylhexyl Chloroformate 24468-13-1 2-Isopropyl-4-(N-methylaminomethyl) thiazole Hydrochloride 908591-25-3 4,4,4-Trifluoro-1-(4-methylphenyl)-1,3-butane dione 720-94-5 4,5,6,7-Tetrahydrothieno[3,2,c] pyridine Hydrochloride 28783-41-7 4-Chloro-N-methyl-piperidine 5570-77-4
    [Show full text]
  • Efficacy of Different Types of Therapy for COVID-19
    life Review Efficacy of Different Types of Therapy for COVID-19: A Comprehensive Review Anna Starshinova 1,*, Anna Malkova 2 , Ulia Zinchenko 3 , Dmitry Kudlay 4,5 , Anzhela Glushkova 6, Irina Dovgalyk 3, Piotr Yablonskiy 2,3 and Yehuda Shoenfeld 2,7,8 1 Almazov National Medical Research Centre, Head of the Research Department, 2 Akkuratov Str., 197341 Saint-Petersburg, Russia 2 Medical Department, Saint Petersburg State University, 199034 Saint-Petersburg, Russia; [email protected] (A.M.); [email protected] (P.Y.); [email protected] (Y.S.) 3 St. Petersburg Research Institute of Phthisiopulmonology, 199034 Saint-Petersburg, Russia; [email protected] (U.Z.); [email protected] (I.D.) 4 NRC Institute of Immunology FMBA of Russia, 115478 Moscow, Russia; [email protected] 5 Medical Department, I.M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia 6 V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, 192019 Saint Petersburg, Russia; [email protected] 7 Ariel University, Kiryat HaMada 3, Ariel 40700, Israel 8 Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 5265601, Israel * Correspondence: [email protected]; Tel.: +7-9052043861 Citation: Starshinova, A.; Malkova, Abstract: A new coronavirus disease (COVID-19) has already affected millions of people in 213 coun- A.; Zinchenko, U.; Kudlay, D.; tries. The possibilities of treatment have been reviewed in recent publications but there are many Glushkova, A.; Dovgalyk, I.; controversial results and conclusions. An analysis of the studies did not reveal a difference in Yablonskiy, P.; Shoenfeld, Y. Efficacy mortality level between people treated with standard therapy, such as antiviral drugs and dexam- of Different Types of Therapy for ethasone, and new antiviral drugs/additional immune therapy.
    [Show full text]
  • Development and Validation of a Stability-Indicating LC-Method For
    Sci Pharm www.scipharm.at Research article Open Access Development and Validation of a Stability-Indicating LC-Method for the Simultaneous Estimation of Levodropropizine, Chloropheniramine, Methylparaben, Propylparaben, and Levodropropizine Impurities 1 1 Palakurthi Ashok KUMAR * , Thummala Veera Raghava RAJU , 1 1 2 Dongala THIRUPATHI , Ravindra KUMAR , Jaya SHREE 1 Analytical Research and Development, Integrated Product Development, Dr. Reddy’s Laboratories Ltd., Bachupally, Hyderabad-500 072, India. 2 Centre for Chemical Science and Technology, J. N. T. University, Kukatpally, Hyderabad, A.P., India. * Corresponding author. E-mail: [email protected] (P. A. Kumar) Sci Pharm. 2013; 81: 139–150 doi:10.3797/scipharm.1210-18 Published: November 17th 2012 Received: October 18th 2012 Accepted: November 17th 2012 This article is available from: http://dx.doi.org/10.3797/scipharm.1210-18 © Kumar et al.; licensee Österreichische Apotheker-Verlagsgesellschaft m. b. H., Vienna, Austria. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract A simple, fast, and efficient RP-HPLC method has been developed and validated for the simultaneous estimation of Levodropropizine, Chloropheniramine, Methylparaben, Propylparaben, and the quantification of Levodropropizine impurities in the Reswas syrup dosage form. A gradient elution method was used for the separation of all the actives and Levodropropizine impurities by using the X-Bridge C18, 150 mm × 4.6 mm, 3.5 μm column with a flow rate of 1.0 mL/min and detector wavelength at 223 nm.
    [Show full text]
  • EUROPEAN PHARMACOPOEIA 10.0 Index 1. General Notices
    EUROPEAN PHARMACOPOEIA 10.0 Index 1. General notices......................................................................... 3 2.2.66. Detection and measurement of radioactivity........... 119 2.1. Apparatus ............................................................................. 15 2.2.7. Optical rotation................................................................ 26 2.1.1. Droppers ........................................................................... 15 2.2.8. Viscosity ............................................................................ 27 2.1.2. Comparative table of porosity of sintered-glass filters.. 15 2.2.9. Capillary viscometer method ......................................... 27 2.1.3. Ultraviolet ray lamps for analytical purposes............... 15 2.3. Identification...................................................................... 129 2.1.4. Sieves ................................................................................. 16 2.3.1. Identification reactions of ions and functional 2.1.5. Tubes for comparative tests ............................................ 17 groups ...................................................................................... 129 2.1.6. Gas detector tubes............................................................ 17 2.3.2. Identification of fatty oils by thin-layer 2.2. Physical and physico-chemical methods.......................... 21 chromatography...................................................................... 132 2.2.1. Clarity and degree of opalescence of
    [Show full text]
  • Poison Act 1952
    LAWS OF MALAYSIA _____________ ONLINE VERSION OF UPDATED TEXT OF REPRINT _____________ Act 366 POISONS ACT 1952 As at 1 February 2019 2 POISONS ACT 1952 First enacted … … … … 1952 (Ord. No. 29 of 1952) Revised … … … … 1989 (Act 366 w.e.f. 13 April 1989) Latest amendment made by P.U. (A) 8/2019 which came into operation on … … 10 January 2019 PREVIOUS REPRINTS First Reprint ... ... ... ... ... 2001 Second Reprint ... ... ... ... ... 2006 3 LAWS OF MALAYSIA Act 366 POISONS ACT 1952 ARRANGEMENT OF SECTIONS Section 1. Short title and application 2. Interpretation 3. Establishment of Poisons Board 4. Proceedings of Board 5. Powers of Board to regulate proceedings 6. Power of Minister to amend Poisons List 7. Application of the Act 8. Control of imports of poisons 9. Packaging, labelling and storing of poisons 10. Transport of poisons 11. Control of manufacture of preparations containing poison 12. Control of compounding of poisons for use in medical treatment 13. Possession for sale of poison and sale of poison in contravention of this Act an offence 14. Control of acetylating substances 15. Sale of poisons by wholesale 16. Sale of poisons by retail 17. Prohibition of sale to persons under 18 18. Restriction on the sale of Part I poisons generally 19. Supply of poisons for the purpose of treatment by professional men 20. Group A Poisons 21. Group B Poisons 4 Laws of Malaysia ACT 366 Section 22. Group C Poisons 23. Group D Poisons 24. Prescription book 25. Sale of Part II Poisons 26. Licences 27. Register of licences 28. Annual list to be published 29.
    [Show full text]
  • 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
    [Show full text]
  • A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine
    http://dx.doi.org/10.3349/ymj.2013.54.1.262 Case Report pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 54(1):262-264, 2013 A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine Kyung Hee Park,1,2 Il Seon Yun,1,2 Soo-Young Choi,2 Jae-Hyun Lee,1,2 Chein-Soo Hong,1,2 and Jung-Won Park1,2 1Division of Allergy and Immunology, Department of Internal Medicine, 2Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea. Received: May 17, 2012 We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levo- Revised: June 7, 2012 dropropizine. The patient was an 18-year old Korean woman. After taking the Accepted: June 7, 2012 common cold medication including acetaminophen, domperidone, and levodro- Corresponding author: Dr. Jung-Won Park, propizine, skin rash, angioedema and anaphylaxis were developed immediately. Division of Allergy and Immunology, As she was tolerable to acetaminophen alone, we thought the culprit agent was Department of Internal Medicine, Yonsei University College of Medicine, maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick 50 Yonsei-ro, Seodaemun-gu, test and oral drug provocation test with the suspected one. Finally we detected le- Seoul 120-752, Korea. vodropropizine specific IgE and confirmed the specificity by inhibition enzyme- Tel: 82-2-2228-1961, Fax: 82-2-393-6884 linked immunosorbent assay (ELISA). E-mail: [email protected] Key Words: Levodropropizine, anaphylaxis, drug hypersensitivity ∙ The authors have no financial conflicts of interest. INTRODUCTION Levodropropizine is widely used peripheral acting antitussives. It suppresses cough through inhibition of vagal C-fiber and its neuropeptide.1 Previously report- ed adverse drug reactions of levodropropizine were nausea, diarrhea and epigastric discomfort.2 Only two cases of anaphylaxis to levodropropizine were reported,3,4 but the mechanism of levodropropizine anaphylaxis is not yet clarified.
    [Show full text]
  • WHO-EMP-RHT-TSN-2018.1-Eng.Pdf
    WHO/EMP/RHT/TSN/2018.1 The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances FORMER DOCUMENT NUMBER: WHO/PHARM S/NOM 15 WHO/EMP/RHT/TSN/2018.1 © World Health Organization [2018] Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances. Geneva: World Health Organization; 2018 (WHO/EMP/RHT/TSN/2018.1). Licence: CC BY-NC-SA 3.0 IGO.
    [Show full text]
  • Efficacy of Levodropropizine in the Pediatric Setting: a Meta-Analysis of Published Studies
    Review Efficacy of levodropropizine in the pediatric setting: a meta-analysis of published studies Summary Cough in children is among the most common symptoms and may have a deep impact on children’s and parents’ sleep and quality of life, thus often requiring an empiric treatment with antitussive agents. Levodro- propizine is a very well tolerated peripheral drug, while central cough suppressants (opioids and non opioids) may be associated with side effects that limit their use especially in children. After comprehensive literature search, a meta-analysis of 4 clinical studies of levodropropizine vs. control, including a total of 780 patients, was performed with the aim to evaluate the overall comparative efficacy of levodropropizine in the pediatric population. Meta-analysis of all standardized efficacy parameters (cough frequency, severity, and night awake- nings) showed a highly statistically significant difference in the overall antitussive efficacy in favor of levodro- propizine vs. control treatments (p=0.0044). The heterogeneity test for the efficacy outcome was not statisti- cally significant (p=0.0856). Our meta-analysis indicates that levodropropizine is an effective antitussive drug in children, with statistically significant better overall efficacy outcomes vs. central antitussives (codeine, clope- rastine, dextromethorphan), in terms of reducing cough intensity, frequency and nocturnal awakenings. These results further reinforce the favorable benefit/risk profile of levodropropizine in the management of cough in the pediatric setting. De Blasio F, Lanata L, Dicpingaitis PV, et al. Efficacy of levodropropizine in the pediatric setting: a meta-analysis of published studies. Trends Med 2013; 13(1):9-14. ©2013 Pharma Project Group srl. ISSN: 1594-2848 1 Francesco De Blasio , Luigi Introduction Cough resulting from URTI, al- Lanata2, Peter V.
    [Show full text]
  • Pharmacological Drugs Inducing Ototoxicity, Vestibular Symptoms and Tinnitus: a Reasoned and Updated Guide
    European Review for Medical and Pharmacological Sciences 2011; 15: 601-636 Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide G. CIANFRONE1, D. PENTANGELO1, F. CIANFRONE2, F. MAZZEI1, R. TURCHETTA1, M.P. ORLANDO1, G. ALTISSIMI1 1Department of Otolaryngology, Audiology and Phoniatrics, “Umberto I” University Hospital, Sapienza University, Rome (Italy); 2Institute of Otorhinolaryngology, School of Medicine, Catholic University of the Sacred Heart, Rome (Italy) Abstract. – The present work on drug-in- Introduction duced ototoxicity, tinnitus and vertigo repre- sents the update and revision of a previous The panorama of the pharmacological origin guide to adverse drug reactions for italian physi- iatrogenic noxae able to induce either harmful cians (2005). The panorama of drug-induced side effects causing ototoxicity or symptoms ototoxic effects or just a symptomatology like tin- such as tinnitus or dizziness and vertigo has en- nitus or balance disturbances, without any harm- larged in recent years, thanks to a better knowl- ful consequence, has widened in the last few edge and a more specific attention of pharma- years. The reason for this is the progress of scien- ceutical firms and drug-control institutions. In tific knowledge, the increased awareness of the daily clinical practice, there is a need for the pharmaceutical companies and of the institutions, family physician and the ENT specialist or audi- ologist (also in consideration of the possible which supervise pharmaceutical production. medico-legal implications) to focus the attention Only through continuous updating and experi- on the possible risk of otological side effects. ence sharing it’s possible to offer patients the This would allow a clinical risk-benefit evalua- certainty of receiving the treatment that is appro- tion, weighing the possible clinical advantage in priate, safe and effective and based upon the their field of competence against possible oto- most credited clinical studies.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2009/0176792 A1 Gant Et Al
    US 20090176792A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2009/0176792 A1 Gant et al. (43) Pub. Date: Jul. 9, 2009 (54) SUBSTITUTED Publication Classification DBENZHYDRYLPPERAZINES (51) Int. Cl. A63/4985 (2006.01) (75) Inventors: Thomas G. Gant, Carlsbad, CA C07D 24I/04 (2006.01) (US); Sepehr Sarshar, Cardiff by A63/495 (2006.01) the Sea, CA (US) (52) U.S. Cl. ..................... 514/251544/396; 514/255.04 (57) ABSTRACT Correspondence Address: The present invention relates to new dibenzhydrylpiperazine GLOBAL PATENT GROUP - APX modulators of histamine receptors, pharmaceutical composi Ms. LaVern Hall tions thereof, and methods of use thereof. 10411 Clayton Road, Suite 304 ST. LOUIS, MO 63131 (US) Formula I (73) Assignee: AUSPEX PHARMACEUTICALS, INC., Vista, CA (US) (21) Appl. No.: 12/350,032 (22) Filed: Jan. 7, 2009 Related U.S. Application Data (60) Provisional application No. 61/019.520, filed on Jan. 7, 2008. US 2009/0176792 A1 Jul. 9, 2009 SUBSTITUTED 0005 Disclosed herein is a compound having structural DBENZHYDRYLPPERAZINES Formula I: (I) 0001. This application claims the benefit of priority of U.S. provisional application No. 61/019,520, filed Jan. 7, 2008, the disclosure of which is hereby incorporated by ref erence as if written herein in its entirety. 0002 The present invention is directed to dibenzhy drylpiperazine-based histamine receptor modulators and pharmaceutically acceptable salts and prodrugs thereof, the chemical synthesis thereof, and medical use of Such com pounds for the treatment and/or management of nausea, kine tosis, emesis, Vertigo, dermatitis, migraines, labyrinthitis, Méniere's disease and/or any disorder ameliorated by modu lation of histamine receptors.
    [Show full text]