ASHINGTON, April 7 - Federal drug regulators issued sweeping warnings Thursday that many popular painkillers could hurt the heart, stomach or skin, and they persuaded Pfizer to withdraw its pain pill Bextra, once a strong seller. Tough warnings about heart risks will soon dominate the labels for prescription painkillers like Celebrex, Mobic, Naprosyn, Voltaren and more than a dozen other similar drugs, the Food and Drug Administration announced. Even the labels of popular over-the-counter pills like Advil and Aleve will have to cite risks to heart, stomach and skin, the agency said. Few studies have examined the long-term health effects of most of these medicines, so regulators are groping a bit in the dark. Studies done on Bextra and Celebrex, both from Pfizer, and Vioxx, made by Merck, strongly suggest that they increase the risks of heart attacks and strokes. With those studies in hand and suggestions that older pills may act similarly, F.D.A. officials said that they could not rule out the possibility that all of the drugs in the class known as nonsteroidal anti-inflammatories cause similar problems. Several doctors interviewed said they would now weigh the risks and benefits case by case. [Page C4.] "We think these risks apply to all of these drugs, " said Dr. Steven Galson, acting director of the F.D.A.'s center for drugs. "There may be some differences, but our conclusion is that we don't have enough data to rank-order these risks." Still, Dr. Galson emphasized that popular over-the-counter pain pills were safe if taken briefly and in low doses, and patients should not suddenly stop taking these medicines because of the F.D.A.'s announcement. Several experts said that naproxen, the medicine found in Naprosyn and Aleve, is probably the safest among the nonsteroidal pain pills. Neither acetaminophen, sold as Tylenol and other names, nor aspirin are affected by the new warnings, although those medicines are not problem-free. In high doses, aspirin can hurt the stomach and Tylenol can damage the liver. Aspirin, though, protects the heart. The latest warnings will complicate prescribing decisions for arthritis patients and others in chronic pain. There are hints in the research that the pain pills that are easiest on the stomach may be toughest on the heart, and vice versa. Aspirin, for instance, protects the heart but can irritate the stomach. Naproxen may be mildly protective to the heart but seems especially harsh on the stomach. Vioxx proved easiest on the stomach but probably has the most toxic effects on the heart. All, in rare cases, cause skin reactions. Doctors must now ask about a patient's heart and stomach risks. Those with cardiovascular problems could get one kind of pill, and those with a history of ulcers may get another. And some drugs have uniquely beneficial effects in some patients, who may prefer to accept a measure of risk to continue taking their favored drug. The difficulties may be particularly acute for the elderly, who are often at risk for stomach and heart problems. Pfizer said in a statement that it "respectfully disagrees with F.D.A.'s position regarding the overall.
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To refill Krahn's prescriptions for Paxil, Meclizine, Celebrex, and Vicodin, but she did not see him again until March 2001. Tr. 279-84, 365 ; On December 19, 2000, Dr. Suresh Mahawar evaluated Krahn for the Disability Determination Bureau "DDB" ; . Tr. 252-54 ; examination was normal except for Krahn's gait. This.
Prostaglandins are powerful signaling agents in the human body. The two-dozen or so members of this family of small lipid messengers underpin many profound physiological events -- including vasodilation, vasoconstriction, bronchoconstriction, platelet activation, inflammation, uterine contractions, pain perception and fever. Drugs to counter their less desirable effects have become permanent residents in medicine cabinets around the world, and for a good reason -- they are effective, cheap and reasonably safe. Nevertheless, history has shown that, with new information from basic research, a drug can usually be improved. For example, the results of a study reported on page 291 of this issue of Nature Structural Biology shed light on a particular enzyme involved in prostaglandin metabolism. Information such as this may eventually lead to even better prostaglandin-blocking compounds than those available today. First discovered in seminal fluid in the early 1930s, prostaglandins are now known to be important regulators in many parts of the body. In 1982, the Nobel Prize in Physiology or Medicine was presented to three scientists, Sune K. Bergstrm, Bengt I. Samuelsson and John R. Vane, for their work on this family of hormones. Vane's contributions include showing that one of the world's most widely used drugs -- aspirin -- acts to relieve pain, fever and inflammation by blocking the production of prostaglandins. The long history of aspirin and other pain relievers emphasizes the importance of this discovery. The ancient Egyptians and Romans were already aware that certain plants could be used to treat pain and fever. Hippocrates also championed the chewing of willow bark for pain relief. In England in 1763, the Reverend Edward Stone published a widely read paper promoting the benefits of willow bark extract, and in the 1820s salicylic acid was identified as the bark's active component. In 1860, a process for mass-producing salicylic acid was discovered. Soon after, many unfortunate patients learned the hard way that the pure form of salicylic acid is not well tolerated, causing diarrhea and vomiting. A search for alternatives ensued, and in the late 1890s, Felix Hoffman of the Bayer Company in Germany found that acetylsalicylic acid was a better choice. It was marketed under the trade name Aspirin, with `a' for the acetyl group and `spir' for the botanical genus spiraea, from which salicylates can be extracted. Aspirin was the main treatment for pain and fever for nearly 60 years. However, its widespread use highlighted significant problems -- it could cause peptic ulcers and was linked to Reye's syndrome, a rare but serious problem in children. Once again, alternatives to combat pain and fever were sought. Thus began the world's current preference for acetaminophen, ibuprofen and other related drugs. Acetaminophen was identified as a pain reliever in the 1890s, even before aspirin was discovered, but it did not enter widespread use until the 1950s. A small drug company called McNeil Laboratories in Pennsylvania began marketing acetaminophen under the brand name Tylenol in 1955. Unlike aspirin, acetaminophen is strictly an analgesic and antipyretic. It does not reduce inflammation, but nor does it upset the stomach. However, acetaminophen at high doses can cause liver failure. Clearly, no drug is perfect. In the 1960s, scientists at the Boots Pure Drug Company in the UK discovered that the phenylalkanoic class of acids, of which ibuprofen is a member, are also good pain killers, fever reducers and anti-inflammatory agents. Clinical trials with ibuprofen were conducted in the 1970s, and in the early 1980s it reached drugstore shelves under the trade names of Nuprin, Advil and Motrin. Related compounds, such as naproxen known as Aleve ; and ketoprofen known as Orudis ; are also now available. All of these can cause stomach upset, but usually less so than aspirin. It is now known that all of these drugs block the activities of cyclooxygenase COX ; , enzymes that act early in the pathways of prostaglandin synthesis. So far, three COX enyzymes have been identified: COX-1 is involved in protecting the gastrointestinal tract from acid assault; COX-2 is involved in pain, fever, and inflammation; and the role of the newly discovered COX-3, which is expressed primarily in the brain and heart, remains obscure. Both aspirin and ibuprofen inhibit COX-1 and COX-2, but acetaminophen appears to inhibit only COX-3. Very recently, additional anti-inflammatory agents have been introduced, ones that inhibit COX-2 but not COX-1. These compounds, Celecoxib known as Celrbrex ; and rofecoxib known as Vioxx ; , have become some of the fastest selling drugs on the market. However, they too have their problems, as they promote blood clotting which may lead to heart attack and stroke in rare cases. The information from basic research has laid the foundation for the development of drugs against each of the cyclooxygenase subtypes. However, with each powerful drug, new side effects have also emerged. This points to the need to better understand the production and function of various prostaglandins in the body. With increased knowledge in this area, perhaps it will eventually be possible to make yet more specific drugs tailored to each prostaglandin action. One day we may use one drug to dull pain, another to reduce blood clotting, yet another to lower fever, and so forth -- a pill for every prostaglandin's purpose.
Two other large insurers, wellpoint health networks inc and aetna healthcare, have restricted the use of celebrex.
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Medicare Part B carriers used a least costly alternative "LCA" ; policy, whereby claims for Lupron and Zoladex were reimbursed based on the AWP for the less costly of the two. DX 2075 at I and celexa.
But the drug had caused the once-upbeat and rambunctious boy to become a withdrawn insomniac who ate only one meal a day.
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Chile Novartis Chile S.A., Santiago de Chile . China Beijing Novartis Pharma Ltd., Beijing . Novartis Pharmaceuticals HK ; Limited, Hong Kong . Shanghai Novartis Trading Ltd., Shanghai . Colombia Novartis de Colombia S.A., Santaf de Bogot . Croatia Lek Zagreb d.o.o., Zagreb . Czech Republic Novartis s.r.o., Prague . Denmark Novartis Healthcare A S, Copenhagen . Ecuador Novartis Ecuador S.A., Quito . Egypt Novartis Pharma S.A.E., Cairo . Novartis Egypt Healthcare ; S.A.E., Cairo . Finland Novartis Finland Oy, Espoo . France Novartis Groupe France S.A., Rueil-Malmaison . Novartis Pharma S.A.S., Rueil-Malmaison Sandoz S.A.S., Levallois-Perret Novartis Sant Familiale S.A.S., Rueil-Malmaison e Novartis Sant Animale S.A.S., Rueil-Malmaison e Novartis Nutrition S.A.S., Revel . Nutrition et Sant S.A.S., Revel . CIBA Vision S.A.S., Blagnac . Equity interest and cipro.
Article by Mary Beth Bradley, PharmD Candidate, Campbell University School of Pharmacy Note: NMG external consultant pharmacists will be forwarding a recommendation on each patient receiving Bextra and Cflebrex to have the physician prescriber evaluate the continued use of the product. This recommendation will also provide alternatives to the current therapy when appropriate.
38. Norton L. A Gompertzian model of human breast cancer growth. Cancer Res 1998; 48: 706771. Lu Y, Zi X, Zhao Y, Mascarenhas D, Pollak M. Insulin-like growth factor-I receptor signaling and resistance to trastuzumab Herceptin ; . J Natl Cancer Inst Bethesda ; 2001; 93: 18527. Mackey J, Gelmon KA, Verna S, et al. Continued use of Herceptin after disease progression in women with HER2-positive HER2 ; metastatic breast cancer MBC ; : results from a retrospective analysis of 105 cases. Proc Soc Clin Oncol 2002; 21: 207a. Chow LWC, Toi M, Takebayashi Y, Sasano H. Phase II study of the preoperative use of celecoxib CELEBREXTM ; and FEC for the treatment of locally advanced breast cancer. Breast Cancer Res Treat 2003; 71: 229a. Chow LWC, Toi M, Takebayashi Y, Sasano H. Celecoxib antiaromatase neoadjuvant CAAN ; trial for locally advanced breast cancer: second report. Breast Cancer Res Treat 2003; 71: 428a. Dirix LY, Ignacio J, Nag S, et al. Final results from an open-label, multicenter, controlled study of exemestane celecoxib in postmenopausal women with advanced breast cancer ABC ; who progressed on tamoxifen T ; . Proc Soc Clin Oncol 2003; 22: 77a. Canney PA. Improved responses with the combination of exemestane Aromasin ; with the cyclooxygenase-2 inhibitor Celecoxib in postmenopausal patients with ER positive advanced breast cancer. Breast Cancer Res Treat 2003; 71: 438a. Altorki NK, Keresztes RS, Port JL, et al. Celecoxib, a selective cyclo-oxygenase-2 inhibitor, enhances the response in preoperative paclitaxel and carboplatin in early-stage non-small-cell lung cancer. J Clin Oncol 2003; 21: 264550. Lin EH, Morris JS, Ayers GD. Effect of celecoxib on capecitabineinduced hand-foot syndrome and antitumor activity. Oncology Huntingt ; 2002; 16 12 Suppl No. 14 ; : 317 and claritin.
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WHAT ABOUT CONFIDENTIALITY? Efforts will be made to keep your personal information confidential. We cannot guarantee absolute confidentiality. Records of your progress while on the study will be kept in a confidential form at this institution and in a computer file at the headquarters of the Radiation Therapy Oncology Group RTOG ; . Your personal information may be disclosed if required by law. Organizations that may inspect and or copy your research records for quality assurance and data analysis include groups such as the Food and Drug Administration FDA ; , the National Cancer Institute NCI ; , qualified representatives of applicable drug manufacturers, and other groups or organizations that have a role in this study. WHAT ARE THE COSTS? 8 20 02 ; Taking part in this study may lead to added costs to you or your insurance company. Please ask about any expected added costs or insurance problems. The CelebrexTM will be provided to you by the drug company at no cost to you while you are on the study. In the case of injury or illness resulting from this study, emergency medical treatment is available but will be provided at the usual charge. No funds have been set aside to compensate you in the event of injury. You or your insurance company will be charged for continuing medical care and or hospitalization. You will receive no payment for taking part in this study. WHAT ARE MY RIGHTS AS A PARTICIPANT? Taking part in this study is voluntary. You may choose not to take part or may leave the study at any time. Leaving the study will not result in any penalty or loss of benefits to which you are entitled. We will tell you about new information that may affect your health, welfare, or willingness to stay in this study and
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Ruberti RF et al. Epilepsy in the Kenyan. Afr. J. Neurol. Sci, 1985; 41: 3640. Ruberti RF, Post-traumatic epilepsy. Afr. J. Neurol. Sci, 1986; 5: 917. Rwiza HT et al. Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study. Epilepsia, 1992; 33: 10516. Snow RW et al. The prevalence of epilepsy among a rural Kenyan population. Its association with premature mortality. Trop Geogr Med, 1994; 46: 1759. Tekle-Haimanot R et al. Clinical and electroencephalographic characteristics of epilepsy in rural Ethiopia: a community-based study. Epilepsy Res, 1990; 7: 2309 Tekle-Haimanot R, Forsgren L, Ekstedt J. Incidence of epilepsy in rural central Ethiopia. Epilepsia, 1997; 38: 5416. Thiam I. Facteur de risque dans l'pilepsie propos d'enqute en zone sub-urbaine ; . Thse Md., Dakar, 1989, No. 31. Uchoa E et al. Reprsentations culturelles et disqualification sociale. L'pilepsie dans trois groupes ethniques du Mali. Epilepsia, 1992; 33: 6: United Nations Development Program UNDP ; . Human Development Indicators. 2001 Programme des United Nations Economic Commission for Africa. An alternative framework to structural adjustment: programme for socio-economic recovery and transformation. Addis Ababa: UNECA, 1989. Voskuil PH. A survey of 100 patients in a primary health care setting in Liberia. Trop Geogr Med, 1994; 46: S18-9. Watts AE. The natural history of untreated epilepsy in a rural community in Africa. Epilepsia, 1992; 33: 4648, for instance, drug store.
Personal Data: We present the case of a 66-year-old female who presented to the Mayo Clinic Department of Physical Medicine and Rehabilitation in Jacksonville, Florida with limited range of motion. The patient was a retired professional musician who was currently competitive as an amateur tennis player. Physical Signs and Symptoms: The patient presented with the chief complaint of significant pain to the anterior chest and axilla, as well as limited range of motion at the glenohumeral joint. The patient also presented with a 3cm open axillary wound at time of evaluation. Differential Diagnosis: 1. Acromioclavicular sprain 2. Adhesive capulitis 3. Bursitis 4. Impingement syndrome 5. Rotator cuff pathology 6. Scapulothoracic dysfunction 7. Tenosynovitis Results of Diagnostic Imaging Laboratory Tests: None. Clinical Course: A medical history revealed that this patient presented to our facility 5 months after completing a modified radical mastectomy and lymph node dissection, as well as radiation therapy and chemotherapy for invasive adenocarcinoma. This patient's treatment for breast cancer included chemotherapy, and radiation therapy to the right breast and surrounding tissues of her dominant side. Radiation was used to ablate the cancerous cells in her breast. However, radiation is also known to adversely effect healthy and normal tissues surrounding the treatment area. Thus, the diagnosis of radiation induced adhesive capsulitis was made. The treatment goal was to restore the athlete's pain free functional abilities. Physical therapy was initiated to control pain and increase range of motion. This was facilitated by massage for skin desensitization and soft tissue mobilization, and followed by early sport-specific range of motion and strengthening exercises. The patient was also progressed to on-court range of motion, strengthening, and skill acquisition activities. Over a 7-month course of increasing ROM and strength, the patient made significant functional gains through a comprehensive rehabilitation regime and returned to her pre-surgical lifestyle of participating in recreational tennis. Deviation from the Expected: This case is unique to the athletic training profession because of the age and pathology of the patient. Radiation is used to destroy cancerous cells in the affected tissue, but can also and clonidine.
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October is Talk About Prescriptions Month a good time to take a closer look at the prescriptions you take. A case in point Celebrex, Celexa, and Cerebyx. Three different prescription drugs that sound and look alike yet do very different things. And one medication safety group is concerned. MICHAEL COHEN, INSTITUTE FOR SAFE MEDICATION: Sometimes the names are being misspelled by the doctors and, unfortunately, the pharmacists are reading the wrong name. And then this results in the wrong medication being given to a patient. Celebre is just one of dozens of drugs that have names very similar to other drugs. To avoid confusion for the pharmacist, doctors are being encouraged to write down the reason any drug is prescribed right on the prescription. Patients can do their part by reading the information that comes with their medication, and by asking their doctor or pharmacist questions. And those are your AccentHealth Headlines.
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Each year millions of people enjoy the most popular natural, drug-free health care system in the world chiropractic! Chiropractic helps people function closer to their physical and emotional best; recover from sickness, disease and disability faster and minimize the use of drugs and surgery in their lives! Many chiropractic users report less stress, more vitality and more enjoyment in life! Chiropractic is a system of health care that releases a serious stress from your body: the subluxation, an often painless, tiny distortion in your spine and structural system that can affect your nerves, muscles, internal organs, discs, bones, brain, posture and overall health. Of course, if you presently are ill and suffering, you need your natural healing ability enhanced so you can better fight disease and return yourself to a state of balance and health. That is a fact no matter what disease or condition you may have. By correcting your subluxations, chiropractors help awaken your natural healing ability to function at its optimum; to awaken your "inner doctor." For millions chiropractic has made the difference between living with pain and living without pain, between living with sickness and living in health, between a fast recovery and a slow recovery and even between life and death. Why live with health problems when you can live without them? Discover chiropractic discover how natural healing can be.
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The Company believes that its existing cash and cash equivalents and short-term marketable securities, as well as cash generated from operations are sufficient to finance its current operations and working capital needs and future product acquisitions. At present, the Company is actively pursuing product acquisitions that may require the use of substantial capital resources. There are no present agreements or commitments with respect to any such acquisitions. Paladin's cash, and short-term and long-term marketable securities decreased $2, 423 to $42, 124 at December 31, 2004 from $44, 547 at December 31, 2003. Working capital decreased $214 to $39, 709 at December 31, 2004 from $39, 923 at December 31, 2003. This decrease is primarily due to a decrease in short-term marketable securities and balance of license agreements payable offset by an increase in accounts receivable and inventory and cozaar.
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Points for all Providers: There are 19 Prescription Drug Plans for our region. Medications and supplies covered by Medicare Part B will need to be submitted to the appropriate carrier. For more detailed information about Medicare Part D, refer to the Medicare Prescription Drug Coverage link on the DMAP website at dmap ate.
Rescue medications are defined as medications used at home when other treatments fail that permit the patient to get relief without a visit to the physician's office or emergency department.11 Information from reference 14.
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Number of Medicaid programs that previously had relied on restrictive formularies. However, the rationality of this increased coverage was perceived to be mixed. Two physician panels agreed that only a quarter of a subset of the top 200 drugs with increased availability over the study period provided a net therapeutic advantage, and that an additional quarter provided no additional clinical benefit at all. This result must be weighed against the disproportionately increased costs experienced by many states that had previously main.
On June 28, 2004, the Board concluded proceedings commenced in May in regard to the medicine Fasturtec by accepting a Voluntary Compliance Undertaking by Sanofi-Synthelabo Canada Inc. Under the terms of the VCU, Sanofi lowered the price of Fasturtec from $295.00 per vial to about $125.00 per vial, effective by July 26, 2004.
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SCHAEFER, JANEK: Skate Rink LP + 3" AUDIOH 011 ; . $19.00 "The original concept for the Skate LP was to make a record that usurped the deterministic spiral and the `anti-skate' mechanism ; as a way of playing and listening to sound on vinyl. To do this I developed the `Fragmented' cutting technique, a method of cutting a concentric collage of individual short `sound scars' onto the disc. When played, the stylus navigates it's own random path across this intermittent terrain of physical sonic diversions. The type of record player, its speed and the user will all affect the result and thus each and every playback of the LP will elicit a different composition. Rink is a composition using sounds sourced from the LP combined with live room recordings taken from the Skate Installation at Triskel Arts, in Cork, Ireland, August 2001. The CD started with a single copy of the LP. Firstly, 60 rhythmic and textural sound events were recorded by playing the LP on the Tri-Phonic Turntable in different ways. 30 silent tracks of varying lengths were then added to create a master source CDr. A copy of this CDr was then loaded into 3 CD players and broadcast in random mode and recorded together. A copy of the installation room recording was then added and the result was then melded `on screen'. Rink was composed in spring 2002 by the invitation of Staalplaat." SCHAEFER, JANEK: Pulled Under CD AUDIOH 012 ; . $15.00 "New full length and follow up to Above Buildings album for Fatcat a year ago which was awareded an `honorary mention' at the Prix Ars Electronica ; Pulled Under forms an enveloping and dense stream of macrosonic soundscapes. Navigating fluidly through a series of absorbing and granular abstract environments." SCHAEFER, JANEK: On Off LP AUDIOH 09 ; . $13.00 "This record develops my invented `eccentric' [off-centre] cutting technique into a more purely sonic scientific based project, leaving `music' to one side. The one sided LP has just two `tracks' or cuts [each ending in locked grooves] which both contain the same continuous full frequency drone tone sourced from a test tone 45 played at 8 rpm. In this instance the inner track is cut symmetrically, and on the same side the outer track is cut off centre which turns the identical `monotonous' stereo tone drone into a pronounced sine wave sound as the arm sways from side to side. The release comes in a numbered edition of 280, in see through faintly sepia toned vinyl with full colour labels, packaged in minimal white spined, hand scalpel cut sleeves. This LP is one in a series of records which aims to re-examine the potential of vinyl to alter sound through the processes of manufacturing and play back. The next in the series `Skate' will be cut using short scars of textural sound which allow the tone arm to navigate freely across the disc, for instance, synthroid.
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