Drugs Log

Treatment with metformin or lifestyle changes promoting exercise and a healthy diet are both effective in reversing the weight gain associated with antipsychotic medications, according to a clinical trial conducted in China. However, a combination of the two approaches is even better.

Metformin, sold under various trade names such as Glucophage, is primarily used to lower blood sugar in patients with type 2 diabetes.

Dr. Jing-Ping Zhao and associates at the Mental Health Institute of the Second Xiangya Hospital in Changsha note that by lowering glucose production in the liver, metformin prevents weight gain and decreases insulin resistance.

However, its effect on the metabolic complications of antipsychotic medication has not been established, the researchers point out in the Journal of the American Medical Association.

Zhao’s group enrolled 128 adults with schizophrenia who gained more than 10 percent of their body weight after taking an antipsychotic drug for 1 year. They were randomly assigned to receive metformin, placebo, lifestyle interventions plus metformin, or lifestyle interventions plus placebo.

The lifestyle intervention included an educational program, the American Heart Association’s step 2 diet and daily moderate exercise for at least 30 minutes.

“To keep patients with schizophrenia compliant with treatment, they all had to be under the care of their parents or another adult caregiver,” Zhao told Reuters Health.

The subject’s average body mass index was 24.5 at the beginning of the study and the average weight was 64.6 kg (142.4 lbs).Body mass index (BMI) is the ratio of height to weight commonly used to classify individuals as underweight, overweight or in a normal weight range. A BMI of 24.5 is at the top end of the normal range.

After 12 weeks, all measured outcomes had worsened in the placebo group, including a weight gain of 3.1 kg (6.8 lbs).

In the metformin group, all outcomes had improved; subjects lost an average of 3.2 kg (7.1 lbs). Subjects in the lifestyle intervention group lost 1.4 kg (3.1 lbs).

However, the benefits of combined treatment were significantly greater than those achieved by either intervention alone. Weight loss in the combined treatment group averaged 4.7 kg (10.4 lbs).

“We recommend that lifestyle intervention plus metformin be considered first for those with weight gain. If patients cannot tolerate or adhere poorly to lifestyle intervention, they should consider metformin alone,” Zhao advised.

“Of course, the safety of metformin must be ensured,” Zhao stressed.

The team is currently engaged in the next stage of their research, he added. “We are studying the efficacy of long-term metformin and lifestyle intervention, and different doses of metformin, on antipsychotic-induced weight gain.”

Diabetes Drug May Cut Med-Related Weight Gain

Improved diet, more exercise and the diabetes medication metformin can help people suffering with schizophrenia control the weight gain that typically accompanies their medications, a Chinese study suggests.

Three months of both medication and lifestyle change resulted in a loss of two centimeters around the waist as well as improvement in other health measures, such as insulin resistance, the researchers report in the Jan. 9/16 issue of the Journal of the American Medical Association.

Metformin is typically prescribed to help control blood sugar levels in people with diabetes. Previous research has shown that metformin can prevent weight gain in people with diabetes and may help manage weight in some overweight people.

Doctors prescribe atypical antipsychotic (AAP) medications to manage a variety of psychotic disorder and behavioral disturbances, including schizophrenia. However, the drugs often also affect the body’s metabolism, resulting in unhealthy cholesterol levels, weight gain and glucose intolerance.

A team based at the Mental Health Institute of the Second Xiangva Hospital, Central South University, China, tested the effect of metformin and lifestyle changes, together and separately, on the weight and insulin levels of 128 adults with schizophrenia. All the participants had gained at least 10 percent of their body weight after starting antipsychotic medications.

The participants were randomly assigned to one of four groups for 12 weeks, while continuing their medication: One group received a placebo or sugar pill; the second one received 750 milligrams per day of metformin; the third received 750 milligrams per day of metformin with lifestyle intervention; and the fourth went through the lifestyle intervention alone. The lifestyle interventions included health education, diet and exercise.

An analysis of the data found that patients in the combination group and patients who took either metformin or engaged in lifestyle change all reduced their weight, body-mass index (a measure of height and weight), waist circumference, insulin levels and insulin resistance.

The participants who took metformin and changed their diet and exercise saw a decrease of 1.8 in their body-mass index, 3.6 in insulin resistance and lost two centimeters in waist circumference. Metformin alone resulted in an average loss of 1.2 in body-mass index, 3.5 in insulin resistance and 1.3 centimeters from the waist. Those who only exercised and changed their diet saw a loss of 0.5 in body-mass index and 1.0 in insulin resistance, but they were no slimmer at the waist. People who took the placebo continued to increase in body mass, waist and insulin resistance, said the researchers.

Metformin

Brand Names: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

What is metformin?

Metformin is an oral diabetes medicine that helps control blood sugar levels.

Metformin is for people with type 2 (non-insulin-dependent) diabetes.

Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.

Metformin may also be used for purposes other than those listed in this medication guide.
What is the most important information I should know about metformin?
Do not use metformin if you have kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking metformin, tell your doctor if you have liver disease or a history of heart disease.
Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin. Be sure the doctor knows ahead of time that you are using metformin.
Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar.

What should I avoid while taking metformin?

Avoid drinking alcohol while taking metformin. Alcohol lowers blood sugar and may increase the risk of lactic acidosis while you are taking this medicine.

Metformin side effects
Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Stop using metformin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling short of breath, even with mild exertion;
• swelling or rapid weight gain; or
• fever, chills, body aches, flu symptoms.

Less serious side effects may include:

• headache or muscle pain;
• weakness; or
• mild nausesa, vomiting, diarrhea, gas, stomach pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

Eli Lilly and Co on Tuesday said U.S. regulators approved once-daily use of two low-dose forms of its Cialis anti-impotence drug, offering greater convenience for men expecting frequent sexual activity.

The Indianapolis drugmaker said the once-daily formulations, in dosages of 2.5 milligrams and 5 milligrams, will allow men to attempt sexual activity any time between doses.

“In clinical trials, when taken without restrictions on the timing of sexual activity, Cialis for once daily use improved erectile function over the course of therapy,” Lilly said in a release.

The low-dose daily formulations, already approved in parts of Europe, “may be most appropriate for men with erectile dysfunction who anticipate more frequent sexual activity (e.g. twice weekly),” Lilly said.

The company said the low-dose formulations provide “a new option for men who may be looking for a dosing option that can be taken without regard to timing of sexual activity.”

The treatment, which has global annual sales of $1.2 billion, has been available in the United States since 2003 in dosages of 5 milligrams, 10 milligrams and 20 milligrams, and taken as needed. Those dosages provide effectiveness for up to 36 hours.

Company spokeswoman Keri McGrath said no dosage forms of the medicine, including the newly approved lower ones, are appropriate for heart patients who take nitrates, including nitroglycerin.

Members of the class of drugs to which Cialis belongs — including Pfizer Inc’s rival Viagra and GlaxoSmithKline Plc’s Levitra — can dangerously lower blood pressure when used alongside nitrates.

The drugs, used by millions of men worldwide, also carry new warnings about potential risk of sudden hearing loss.

Shares of Lilly were up $1.05, or 1.9 percent, to $55.60 in morning trading on the New York Stock Exchange, in line with a 2 percent advance for the drug sector.

Cialis Information

Generic Name: tadalafil

Brand Names: Cialis

What is tadalafil?

Tadalafil relaxes muscles and increases blood flow to particular areas of the body.

Tadalafil is used to treat erectile dysfunction (impotence).

Tadalafil may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about tadalafil?
Do not take tadalafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (”poppers”). Taking tadalafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of tadalafil Do not take tadalafil more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Tadalafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking tadalafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether tadalafil is the actual cause of vision loss.
Stop using tadalafil and get emergency medical help if you have sudden vision loss.

How should I take tadalafil?

Take tadalafil exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.
Take this medication with a full glass of water.

Tadalafil can be taken with or without food.

Tadalafil is usually taken only when needed, just before sexual activity. The medication can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.
Do not take tadalafil more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. Store this medication at room temperature away from moisture and heat.

French customs officials have intercepted a shipment of 224,000 fake Viagra and Cialis anti-impotence pills worth 2.4 million euros ($3.5 million), the Budget Ministry said on Monday.

The copies of the best-selling drugs were found on December 18 during a search at the French capital’s main air hub at Roissy, in a freight cargo on its way to Brazil from India.

“Branded Powergra and Erectalis, each box contained, in fact, four tablets in the characteristic shape and color of Viagra or Cialis pills,” Budget Minister Eric Werth’s office, which is also in charge of customs, said in a statement.

“The companies Pfizer and Eli Lilly, which respectively own the Viagra and Cialis brands, quickly confirmed the counterfeit nature of these products and the 224,000 pills were seized,” Werth’s office added.

Fake Viagra maker given 10-year prison term

A man has been given a 10-year prison sentence for producing millions of fake anti-impotence pills.

Viagra, the anti-impotence drug, is made by Pfizer. [file photo]

Wang Weiping was also fined 2 million yuan (US$250,000) in a first ruling on Monday at Shaoxing Intermediate People’s Court in East China’s Zhejiang Province.

The 34-year-old, a legal worker at Kangdeli Health Care Co Ltd in Xinchang County of the province, was arrested in November last year on suspicion of producing and selling counterfeit drugs.

A total of 381,000 fake Viagra pills and 1.4 million counterfeit Cialis tablets, worth a combined total of 241 million yuan (US$29 million) on the market, were also seized from workshops at Kangdeli Health Care, according to a release from the court.

Viagra is produced by the New York-based Pfizer Pharmaceuticals, while Cialis is manufactured by Indianapolis-based Lilly Icos LLC. Both are well-known drugs to treat impotence.

Some of the fake pills were found to contain medical starch, which does not have any curative effect and others had too much sildenafil, the main ingredient of Viagra, and is detrimental to health in large doses, said the release.

Workshops to make the fake drugs were also found in Guannan County of Jiangsu Province, Zhejiang’s neighbouring province.

All counterfeit pills, production machines and materials to make the fake drugs were confiscated.

Wang began making the fake pills in Shaoxing in April last year, and established another manufacturing base at Guannan in Jiangsu Province in June.

Local police and drug administration officials uncovered the case during a crackdown on the production of fake pills.

No counterfeit drugs have actually been found in the marketplace, said Zhang Guojing, director of the Shaoxing Food and Drug Administration.

Wang’s operation is the biggest, in terms of the financial worth of the pills, to have been uncovered in Zhejiang Province.

Erectile dysfunction drugs such as Viagra and Cialis were approved by the Ministry of Health and State Food and Drug Administration as prescription drugs in 1999.

In December last year, seven people in Zhengzhou in Central China’s Henan Province were accused of selling 9.7 million fake tablets of Viagra.

Police bust online Viagra gang

The leader of a gang selling fake Viagra over the internet has been given a four and a half year jail sentence.

Ashish Halai, 33, ordered fake Viagra tablets from suppliers in China and Mexico for 25p each and sold them for as much as ?20 online to people in the US and Europe who were too embarrassed to go to their doctor.

Three other members of the gang were also found guilty and will be sentenced later.

The case came to light after an investigation by the Medicines and Healthcare products Regulatory Agency (MHRA), which estimated that the gang netted at least ?2m from the scam.

Mick Deats, head of enforcement at the MHRA, said: “The MHRA treats every report of a counterfeit medicine as a serious incident. This successful prosecution should serve as a clear signal to those contemplating the supply of counterfeit medicines.

“The public are strongly advised to avoid buying medicines online, where the risk of being provided with counterfeit medicines is greatly increased.”

Halai is a chemist who sold his practice in Bayswater, London but continued to use the name to sell herbal supplements.

The court heard that Halai began selling fake anti-impotence drugs in 2002 passing them off as Viagra and Cialis. He packaged the drugs so skilfully that experts said it would take a trained eye to spot the difference.

Police seized over ?1.5m worth of the fake drugs when they swooped on the gang. The drugs were imported using business courier services and were disguised as pet supplements.

Two Baylor College of Medicine researchers in Houston are working on a cocaine vaccine they hope will become the first-ever medication to treat people hooked on the drug. “For people who have a desire to stop using, the vaccine should be very useful,” said Dr. Tom Kosten, a psychiatry professor who is being assisted in the research by his wife, Therese, a psychologist and neuroscientist. “At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won’t get high and will lose interest.”

The vaccine, currently in clinical trials, stimulates the immune system to attack the real thing when it’s taken.

The immune system — unable to recognize cocaine and other drug molecules because they are so small — can’t make antibodies to attack them.

To help the immune system distinguish the drug, Kosten attached inactivated cocaine to the outside of inactivated cholera proteins.

In response, the immune system not only makes antibodies to the combination, which is harmless, but also recognizes the potent naked drug when it’s ingested. The antibodies bind to the cocaine and prevent it from reaching the brain, where it normally would generate the highs that are so addictive.

“It’s a very clever idea,” says David Eagleman, a Baylor neuroscientist. “Scientists have spent the last few decades figuring out reward pathways in the brain and how drugs like cocaine hijack the system. It turns out those pathways are difficult to rewire once they’ve seen the drug. But the vaccine just circumvents all that.”

Kosten asked the Food and Drug Administration in December to green-light a multi-institutional trial to begin in the spring and is awaiting a response.

Approval would mark a breakthrough in the treatment of cocaine addiction, which now mostly involves psychiatric counseling and 12-step programs. It presumably would be the final clinical hurdle before the vaccine — more than a decade in the making — might be approved for treatment. But one expert warns against expecting too much.

“Addiction vaccines are a promising advance, but it’s unlikely any treatment in this field will work for everyone,” said Dr. David Gorelick, a senior investigator at the National Institute on Drug Abuse. “Still, if they prove successful, they will give those working in drug addiction an important option.”

Scientists testing vaccine for cocaine users

Nothing says drug addiction more than a needle and syringe. But that’s exactly what a team of U.S. researchers believes can help cocaine users kick their menacing habit.

Two Baylor College of Medicine scientists based in Houston have developed a cocaine vaccine that creates antibodies that bind to the drug and prevent it from travelling from the bloodstream to the brain.

Unable to penetrate the brain, the drug can produce no high.

If the vaccine makes it through regulatory hurdles, it would be the first medication approved to treat cocaine addiction.

“It certainly is a way of combining immunology that had not been used before,” Tom Kosten, a professor of psychiatry and neuroscience at Baylor, said in a telephone interview yesterday. “We had always thought of altering the brain as a way to prevent drug abuse. This way, the drug never gets into the brain to begin with.”

Drug addiction treatment has largely been psychiatric counselling and 12-step programs. Dr. Kosten said that won’t go away – any approved vaccine would be complementary to behavioural therapy.

“If it’s approved in the U.S., then getting approval in Canada won’t be that difficult,” he said, adding that, if all goes well, a cocaine vaccine could be available in the United States in four years.

About 50 pharmaceutical options have previously been explored for cocaine addiction.

Dr. Kosten, who has been assisted in his decade-long research by his spouse, Therese Kosten, also a psychologist and neuroscientist at Baylor, asked the U.S. Food and Drug Administration last month to allow a Phase 3 clinical trial to begin this spring, involving 300 patients at six U.S. sites. Other trials are expected in Spain and Italy.

“Because there are no treatments for cocaine addiction, it’s been one of their fast-tracked programs at the FDA,” Dr. Kosten said. He is also at work on vaccines for heroin, nicotine and methamphetamine.

Yesterday, Evan Wood, co-principal investigator of the supervised injection facility evaluation in Vancouver, called the cocaine vaccine “new and provocative.”

“From a societal perspective, cocaine is one of the drugs that continue to be overlooked as one of the big problem drugs in our society,” said Dr. Wood, a physician epidemiologist at the British Columbia Centre for Excellence in HIV/AIDS.

“Crack cocaine is what is driving many of the social problems and public order problems and crime problems, particularly in the Downtown Eastside [of Vancouver].”

Dr. Wood said the “explosive HIV outbreak” in Vancouver’s east side is largely attributed to heroin users switching to cocaine, which leads to “more frequent injections, more chaotic behaviour and more syringe sharing.”

Learning about the immune system is opening all sorts of “avenues and possibilities,” said Dr. Wood. “But whether this is a useful tool remains to be seen.”

Certainly, the science is intriguing.

Since cocaine molecules are so small, the immune system does not recognize them and cannot make antibodies to attack them.

To fix that problem, Dr. Kosten attached inactivated cocaine to the outside of inactivated cholera proteins.

The immune system made harmless antibodies to the combination, but also recognized the drug when it was ingested. The antibodies bound to the cocaine, preventing it from reaching the brain, where the addictive highs are generated.

In Canada, there are no hard figures on how many are currently addicted to cocaine. Studies such as the Canadian Addiction Survey, published in 2004, found that more than 14 per cent of males, and 10.6 per cent of the total population, reported having tried cocaine.

Gerald Sidel, director of Addington Addiction Treatment Centre in Montreal, said yesterday that everybody is looking for the “magic bullet” to treat addictions.

He compared using modified cocaine to treat cocaine addicts to allowing alcoholics to engage in controlled drinking.

“Certainly if there is a way of helping people, I am not adverse to that,” Mr. Sidel said in a telephone interview yesterday. “But don’t treat drug addicts with drugs.”

In the United States, the management of glaucoma costs about $2.5 billion per year. Of the $1.9 billion in direct costs, glaucoma medications account for an estimated 38% to 52% of the total. In an article published in the January 2008 issue of the American Journal of Ophthalmology, researchers from The Texas A&M University System Health Science Center College of Medicine, Temple, Texas; analyzed the economics of medically managing glaucoma. The yearly costs to patients of various topical glaucoma medications were calculated and significant price differences and increases in cost over time were found.

The researchers looked at four classes of pharmaceuticals; ?-blockers, prostaglandins, ?2-agonists and carbonic anhydrase inhibitors. They compared both brand-name and generic formulations, evaluated how accurately the bottles were filled and how accurately the medications could be dispensed by patients. Using results from earlier studies, the increases in Average Wholesale Prices (AWP) were also evaluated from 1999 through 2006.

Nonselective ?-blockers remain the most inexpensive class of glaucoma medications. For all categories of drugs, calculated yearly cost ranged from $150.81 for generic timolol maleate 0.5% (?-blocker), to $697.42 for Cosopt (combination formulation), to as high as $873.98 for a three-times-daily dose of Alphagan P 0.15% (?2-agonist). Among brand name ?-blockers, yearly cost ranged between $203.47 for Timoptic 0.5% and $657.24 for Betoptic S. Generic ?-blockers consistently were more economical than their brand-name counterparts. Yearly cost of prostaglandin analogs ranged from $427.69 for Travatan to $577.62 for Lumigan. The two carbonic anhydrase inhibitors, Azopt and Trusopt, yielded similar economic profiles. The generic selective ?2-agonist brimonidine tartrate 0.2% costs approximately $352.89 and $529.34 per year for the respective two and three drops daily per eye regimens.

AWP trends through two periods, 1999 to 2006 and 2002 to 2006, showed significant increases, even within a category. For example, in the ?-blockers, Betoptic S increased nearly 100 % from 1999 to 2006, while Timoptic, increased only 11.7 %. In the period 2002 to 2006, the AWP of Timoptic remained constant.

Writing in the article, Steven D. Vold states, “Physicians consider many factors when treating patients with glaucoma. Ultimately, the goal of eye care providers is to give the best, most cost-effective care to their patients. Our study addresses the calculated cost per year passed on to the patient for single medication treatment plans…As newer medications and treatment schemes are introduced, future studies will be needed to update the rapidly changing economic information pertaining to the medical management of glaucoma.”

Glaucoma treatment cannot cure the condition, but it can dramatically slow or temporarily halt its progress. Glaucoma can be treated with either medication or surgery. Both of these treatments are aimed at lowering intraocular pressure (IOP), or pressure within the eye. In the United States, medications are usually the first-line of glaucoma treatment. If this fails, then glaucoma surgery is the next treatment considered.

Glaucoma Medications

Glaucoma medications are either oral or topical. Topical medications such as eye drops, eye ointments, or inserts (strips of medication inserted in the corner of the eye) work to reduce IOP either by increasing the outflow of fluid from the eye or by reducing the amount of fluid produced by the eye. To learn more about the condition, examine the risk factors and symptoms of glaucoma. It is important to tell all of your doctors about any glaucoma medications that you are using. In order for these medications to work, you must take them regularly and continuously as they were prescribed.

Topical Glaucoma Medications

There are five types of topical glaucoma medications, each achieving different purposes:

• Miotics increase the outflow of fluid. These include Isopto® Carpine, Ocusert®, Pilocar®, and Pilopine®.
• Epinephrines increase the outflow of fluid. These include Epifrin® and Propine®.
• Beta-blockers reduce the amount of fluid. These include Betagan®, Betimol®, Betoptic®, Ocupress®, Optipranalol®, and Timoptic®.
• Carbonic-anhydrase inhibitors and alpha-adrenergic agonists reduce the amount of fluid present. These include Alphagan®, Iopidine®, and Trusopt®.
• Prostaglandin analogs increase the outflow of fluid through a secondary drainage route. These include Lumigan®, Rescula®, Travatan®, and Xalatan®.

Oral Glaucoma Medications

Your ophthalmologist can also prescribe oral medications to treat glaucoma. Carbonic anhydrase anhibitors are the oral medications most commonly used in the treatment of glaucoma. These include Daranide®, Diamox®, and Neptazane®.

Patients will be started on one medication or a combination of drugs. If a patient does not respond to one type of drug, he or she can be switched to another until all possibilities have been exhausted. Once this happens, the ophthalmologist may recommend glaucoma surgery.
Glaucoma Surgery

For patients who still have an elevated IOP after attempting glaucoma treatment through medication, an ophthalmologist may recommend either laser or conventional surgery.

Glaucoma Laser Surgery

There are three types of glaucoma laser surgery that can be performed in the doctor’s office:

Trabeculoplasty

Trabeculoplasty uses a laser to burn tissue from the trabecular meshwork, a structure within the eye that controls the flow of fluid. This procedure increases the aqueous outflow in the area surrounding the laser spot, relieving pressure within the eye. Pressure is reduced in 60 to 70 percent of the patients in whom a laser trabeculoplasty is performed. This type of glaucoma laser surgery is used to treat patients with open-angle glaucoma.

Iridotomy

Closed-angle glaucoma occurs when the angle between the iris and the cornea in the eye is too small. This causes the iris to block fluid drainage, increasing inner eye pressure. Iridotomy glaucoma laser surgery makes a small hole in the iris, allowing it to fall back from the fluid channel so fluid can drain.

Cyclophotocoagulation

Cyclophotocoagulation uses a laser to burn ciliary tissue, which decreases the production of fluid in the eye. The procedure, performed under local anesthesia, has only recently become available to glaucoma patients to reduce the intraocular pressure. This type of glaucoma laser surgery is used to treat patients who have failed to respond to other types of glaucoma surgery. Many patients will require more than a single treatment. The procedure appears to have significant success and relatively low risk.

Conventional Glaucoma Surgery

If laser surgery fails to lower IOP, the surgeon may recommend conventional glaucoma surgery, known as trabeculectomy or filtering surgery. This is an outpatient procedure involving the removal of a tiny piece of the eye under the eyelid. This conventional glaucoma surgery creates a new drainage path that increases the outflow of fluid from the eye.

Study Compares Two Common Glaucoma Medications

A multinational study group including ophthalmologists from Finland, Germany, Ireland, Spain, and the United Kingdom recently reported the results of their study comparing Xalatan (latanoprost) and Alphagan (brimonidine) at the European Glaucoma Society meeting. The study group sought to determine both effectiveness and safety of the two commonly used glaucoma drops. Hannu Uusitalo, MD, ophthalmologist at the University Hospital, Tampere, Finland, presented the results.

The Study Protocol

A total of 379 patients with glaucoma or ocular hypertension (high eye pressure) were enrolled in the study and randomly assigned to receive one of the two drugs. The ophthalmologists were masked as to which agent individual patients were receiving to prevent observer bias. Baseline eye pressure measurements were taken prior to using the drops. The measurements were repeated at 2 weeks, 3 months, and 6 months after the patients had used the medication. Pressure readings were taken at 10:00 a.m. and 5:00 p.m. on examination days.

Adverse Events

Six months after the initiation of treatment, only 5 patients in the Xalatan group had withdrawn due to either side effects or uncontrolled eye pressure versus 53 patients in the Alphagan group. In the Alphagan group, 14 had ocular allergies to the medicine, 12 had uncontrolled eye pressure, and the remainder withdrew due to side effects or compliance related issues.

Effectiveness Controlling Eye Pressure

Patients in the Xalatan and Alphagan study groups had substantial decreases in eye pressure during the study; however, the group taking Xalatan had statistically significantly lower eye pressures than the Alphagan group. Those in the Xalatan group had a 28% reduction of eye pressure compared with a 21% reduction in the Alphagan group.

Furthermore, a target eye pressure of less than 18 mm Hg was achieved in 57% of the Xalatan patients versus 33% of the Alphagan patients. A pressure reduction of 30% or more was achieved in 42% of the Xalatan patients versus 22% of the Alphagan patients. Only 12% of the patients in the Xalatan group had a pressure reduction from baseline of less than 15%, compared to 32% of patients in the Alphagan group.

Conclusions

This study clearly shows Xalatan lowered intraocular pressure more effectively than Alphagan and had fewer side effects. Furthermore, since Xalatan only needs to be instilled once each day, patients may find it easier to use instead of Alphagan, which is used twice each day.

Despite the study results, patients should realize that glaucoma medications are tailored to the individual and the physician considers many factors when selecting the appropriate medication. This relatively short-term study did not assess the effect of treatment on the optic nerve or the peripheral vision with visual field testing, both key parameters when assessing treatment effect. Finally, as one can see from the above study results, the effect of glaucoma medication varies significantly from one individual to another, both in lowering pressure and side-effects. Therefore, it is certainly possible that Xalatan may be less effective than Alphagan in a given individual. This is why many ophthalmologists treat one eye initially, monitoring the effectiveness of the medication against the patient’s untreated eye.

What is Xalatan?

Xalatan reduces pressure in the eye by increasing the amount of fluid that drains from the eye.
Xalatan is used to treat certain types of glaucoma and other causes of high pressure inside the eye.

Xalatan may also be used for other purposes not listed in this medication guide.

Important information about Xalatan

Do not use Xalatan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Xalatan before putting your contact lenses in.

Xalatan may cause a gradual change in the color of your eyes or eyelids and lashes, as well as increased growth or thickness of your eyelashes. These color changes, usually an increase in brown pigment, occur slowly and you may not notice them for months or years. Color changes may be permanent even after your treatment ends, and may occur only in the eye being treated. This could result in a cosmetic difference in eye or eyelash color from one eye to the other.
Do not allow the dropper to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

After using Xalatan, wait at least 5 minutes before using any other eye drops that your doctor has prescribed.

Before using Xalatan

Do not use Xalatan if you are allergic to latanoprost.

Before using Xalatan, tell your doctor if you are allergic to any drugs, or if you have swelling or infection of your eye.

Xalatan may cause a gradual change in the color of your eyes or eyelids and lashes, as well as increased growth or thickness of your eyelashes. These color changes, usually an increase in brown pigment, occur slowly and you may not notice them for months or years. Color changes may be permanent even after your treatment ends, and may occur only in the eye being treated. This could result in a cosmetic difference in eye or eyelash color from one eye to the other.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Xalatan passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use Xalatan?
Do not use Xalatan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Xalatan before putting your contact lenses in.

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

What is Alphagan?

Alphagan reduces the amount of fluid in the eye, which decreases pressure inside the eye.
Alphagan is used to treat open-angle glaucoma or ocular hypertension (high pressure inside the eye).

Alphagan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Alphagan?
Do not use Alphagan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Before using Alphagan, tell your doctor if you have kidney or liver disease, heart disease, high blood pressure, circulation problems such as Raynaud’s or Buerger’s disease, or a history of fainting or low blood pressure.

Do not use Alphagan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Alphagan before putting your contact lenses in.

Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.
What should I discuss with my healthcare provider before using Alphagan?

You should not use Alphagan if you are allergic to brimonidine.
Do not use Alphagan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Before using Alphagan, tell your doctor if you have:

• kidney disease;
• liver disease;
• heart disease or high blood pressure;
• circulation problems, such as Raynaud’s syndrome or Buerger’s disease; or
• a history of fainting or low blood pressure.

If you have any of these conditions, you may need a dose adjustment or special tests to safely use Alphagan.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Alphagan passes into breast milk or if it could harm a nursing baby. Do not use Alphagan without telling your doctor if you are breast-feeding a baby.

How should I use Alphagan?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Wash your hands before using the eye drops. Do not use Alphagan while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Alphagan before putting your contact lenses in.

Remember . . .

• When putting drops into your eyes, follow doctor’s orders.
• Be sure your doctor knows about any other drugs you may be taking (including over-the-counter items like vitamins and aspirin) and about any allergies you may have.
• Wash your hands before putting eye drops into your eyes.
• Be careful NOT to touch the tip of the dropper to any part of your eye.
• Make sure the dropper stays clean.
• If you are putting in more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.
• Store the eye drops and all medicines out of reach of children.

Steps for Putting in Eye Drops

1. Start by tilting your head backward while sitting, standing, or lying down. With your index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket.
2. Let a drop fall into the pocket
3. Slowly let go of the lower lid. Blinking a few times is all right, but try not to shut your eyes tight or squint. This may push the drops out of your eye.
4. Gently press on the inside corner of your closed eyes with your index finger and thumb for two to three minutes. This will help keep any drops from getting into your system and keep them in your eye, where they are needed.
5. Blot around your eyes to remove any excess.

If you are still having trouble putting eye drops in, here are some additional tips that may help.

If your hands are shaking:

• Try approaching your eye from the side so you can rest your hand on your face to help steady your hand.
• If shaky hands are still a problem, you might try using a 1- or 2-pound wrist weight (you can get these at any sporting goods store). The extra weight around the wrist of the hand you are using can decrease mild shaking.

If you are having trouble getting the drop into your eye:

• It may be easier to tell if the drop has gone into your eye if you keep your drops in the refrigerator. Your eye will feel the liquid when it is cold better than if it is at room temperature.
• If you are still not sure the drop actually got in your eye, put in another drop. The eyelids can hold only about one drop, so any excess will just run out of the eye. It is better to have excess run out than to not have enough medication in your eye.
• If pulling the lower lid out to create a pocket is not working, try this. With your head turned to the side or lying on your side, close your eyes. Place a drop in the inner corner of your eyelid (the side closest to the bridge of your nose). By opening your eyes slowly, the drop should fall right into your eye.

Read the rest of this entry »

GlaxoSmithKline Plc announced further clinical trial results on Sunday underlining the ability of a drug combination including its product Tykerb to fight breast cancer that has spread to the brain.

An extension to an earlier Phase II study involving 49 patients showed 20 percent of those receiving a mix of Tykerb and Roche’s Xeloda experienced at least a 50 percent volume reduction in measurable brain metastases.

The finding is significant because up to a third of women with HER2-positive metastatic breast cancer may develop brain metastases, which occur when cancer spreads from its original site.

The results were presented at the San Antonio Breast Cancer Symposium in San Antonio, Texas.

Tykerb, a once-daily pill, was approved by U.S. regulators in March and won a conditional green light from the European Medicines Agency on Friday.

It is recommended as a treatment, in combination with Xeloda, for patients with advanced or metastatic breast cancer whose tumors over-express protein HER2.

Tykerb kills breast cancer stem cells

A combination drug, Tykerb, known generically as lapatinib, appears to be able to fight breast cancer that has spread to the brain, media reported Tuesday.

For the first time, researchers have shown that the drug can slash the number of cancer stem cells in women with breast cancer, curbing tumor growth.

The latest theory of what causes cancer namely is that stem cells hiding within tumors drive their growth. Conventional treatments fail to cure cancer, according to the theory, because they are targeting the wrong cells.

Six weeks of Tykerb treatment slashed the number of breast cancer stem cells by more than half in 30 women studied, and two-thirds were cancer-free after follow-up treatment, says Jenny Chang, MD, of Baylor University in Houston.

The finding is significant because up to one third of women with HER2-positive advanced breast cancer may develop brain metastases.

About TYKERB/TYVERB(3)

TYKERB/TYVERB (lapatinib) is a first-in-class oral small-molecule inhibitor of the HER2 (ErbB2) tyrosine kinase receptor. Stimulation of HER2 is associated with cell proliferation and with multiple processes involved in tumor progression and metastases. Overexpression of this receptor has been reported in a variety of human tumors and is associated with poor prognosis and reduced overall survival. On March 13, 2007, the United States Food and Drug Administration (FDA) approved TYKERB, in combination with capecitabine, for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2 and who have received prior therapy including an anthracycline, a taxane, and trastuzumab.

TYVERB has been approved in more than 15 countries, and marketing applications for TYKERB/TYVERB have been filed around the world.

About GlaxoSmithKline

GlaxoSmithKline — one of the world’s leading research-based pharmaceutical and healthcare companies — is committed to improving the quality of human life by enabling people to do more, feel better and live longer.

Many medications, both prescription and over-the-counter, can negatively interact with foods, supplements or other drugs.

Here are guidelines to help prevent food-drug interactions, courtesy of the American Academy of Family Physicians:

• Check prescription and over-the-counter drug labels to see if they contain any warnings.
• Follow directions on all medications carefully.
• Unless you get your doctor’s OK, never break up pills and mix them with food, and never empty capsules into food.
• Take medications with a whole glass of water, unless your doctor has given you other instructions. Never take medications with alcohol.
• Don’t take your medications at the same time as you take vitamins or dietary supplements.
• Don’t mix medications in a hot drink, as the heat may affect the medication.

Taking drugs with food may take a bite out of costs

Taking an expensive breast cancer drug on a full stomach – as opposed to an empty one as prescribed – could save a patient or their health authority $1700 (?835) a month or more, according to an analysis of data from clinical trials.

The approach, which might also work for other drugs, is based on the fact that certain foods can delay the breakdown of medications in the body. Doctors stress, however, that people should not yet attempt this cost-cutting method until studies demonstrate its safety.

In general, taking pills with food against the label’s advice can lead to an overdose. For example, drinking grapefruit juice can interfere with the body’s ability to handle cholesterol-lowering statin drugs.

For this reason, pharmaceutical companies must provide the US Food and Drug Administration (FDA) with information on how eating a meal can influence the absorption of their products.

This was the case when GlaxoSmithKline sought approval for its anticancer drug lapatinib (known as Tykerb in the US and Tycerb in Europe).

Higher blood levels

Pharmaceutical companies generally tell patients in early drug trials to take the medication on an empty stomach, as this helps reduce the variables between patients.

In this instance, when researchers later conducted the food-interaction experiments involving lapatinib, they found that taking it at mealtime raised blood levels of the drug far above those shown as safe in previous trials. This meant that the drug label would have to advise patients to take the pill on an empty stomach.

The FDA approved lapatinib in March 2007 to treat breast cancers that have not responded to other medications. Specifically, the drug fights breast cancers that contain an excess of a protein called “human epidermal growth factor receptor 2″ (HER2), and have spread through the body.

This subtype of breast cancer claims the lives about 8000 to 10,000 US women each year, according to the American Cancer Society. But this help does not come cheap. Lapatinib costs a patient roughly $2900 a month, a large sum, particularly for those who lack health insurance.

Ezra Cohen and Mark Ratain at the University of Chicago, Illinois, US wondered if taking advantage of changes in lapatinib absorption after eating could reduce this cost.

Based on clinical trial data submitted to the FDA, they calculated that taking the medication with a low-fat meal or high-fat meal could increase the amount of lapatinib circulating in the blood by 1.7 and 3.3 times, respectively. Adding grapefruit juice to the mix would reduce costs further still.

“We expect that one 250 milligram lapatinib pill accompanied by food and washed down with a glass of grapefruit juice may yield plasma concentrations comparable to five 250 milligram pills on an empty stomach,” Ratain says.

People who pop a pill with a meal, but no grapefruit juice, are calculated to get the equivalent effect of three pills, and would save around $1700 a month.

Experiment warning

“It’s kind of akin to pill splitting,” says Steven Pearson, of Harvard Medical School in Boston, Massachusetts US. But he thinks the approach is unlikely to be the first choice strategy for making medicines more affordable. Pearson is working to develop a review board that would examine ways to improve cost-effectiveness of drugs in the US.

Pearson says that more sweeping changes – such as providing universal health insurance and reaching a consensus on how much patients should have to pay for meds in the first place – should take top priority.

Pharmaceutical companies argue that high drug prices result from the huge investment required in research and development. But patient advocacy groups have countered that much of the extra money goes into the pockets of shareholders, rather than into such research. They say that there is lots of room for price cutting.

While this debate continues, Cohen urges people not to experiment with taking lapatinib with meals until more research demonstrates the safety of doing so. “This is not something that we suggest people try at home. This is something that should be studied,” says Cohen, adding that an overdose of lapatinib could perhaps cause a heart attack.

He says that these types of trials will only happen if the public demands them: “In part it has to come from patient advocacy groups who say this needs to be studied.”

Cohen adds that he and his colleagues are looking at whether taking other medications, such as the immune suppressant rapamycin, with food could possibly lower drug costs.

Taking High Blood Pressure Pills at Night May Be Better for Some

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don’t know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn’t dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they’re at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It’s the latest research in the field of chronotherapy: How our bodies’ internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore’s Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

“I think it’s huge,” says Hopkins’ Dr. Lawrence Appel. “This is our best lead” into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.

“It does make good sense to take some in the morning and some in the evening,” says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older “statin” pills fight cholesterol best if taken at bedtime; they target a liver enzyme that’s most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients’ dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That’s also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

“We know now that you can change medication timing and lower blood pressure at night,” he explains.

That doesn’t mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. “That’s the million-dollar question,” Rahman cautions.

Still, Lundberg says it’s worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn’t hurt.

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don’t know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn’t dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they’re at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It’s the latest research in the field of chronotherapy: How our bodies’ internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore’s Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

“I think it’s huge,” says Hopkins’ Dr. Lawrence Appel. “This is our best lead” into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.

“It does make good sense to take some in the morning and some in the evening,” says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older “statin” pills fight cholesterol best if taken at bedtime; they target a liver enzyme that’s most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients’ dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That’s also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

“We know now that you can change medication timing and lower blood pressure at night,” he explains.

That doesn’t mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. “That’s the million-dollar question,” Rahman cautions.

Still, Lundberg says it’s worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn’t hurt.

See also:

Keep Timing the Tablets: Statistical Analysis of Pill Dissolution Rates Martin J. Crowder

Abstract

The way in which medicinal tablets, pills and capsules dissolve in liquid is important in the pharmaceutical industry, which collects and analyses data to assess the effects of different formulations of a medicine, different storage conditions, etc. The data usually comprise repeated measures, the record for an individual tablet consisting of either the fractions dissolved at a given sequence of time points or the times taken for given fractions to dissolve. Read the rest of this entry »