Jul
16
Alitretinoin
July 16, 2009 | Leave a Comment
Generic Name
Alitretinoin (al-ih-TRET-in-oin)
Brand Name
Panretin
Type of Drug Retinoid.
Prescribed For
Skin lesions of Kaposi’s sarcoma (KS).
General Information
Alitretinoin binds to and activates retinoid receptors in human cells. Once activated, these receptors help stimulate the body’s natural mechanisms for limiting tissue growth—in this case, the growth of KS cells. KS lesions, which are primarily associated with human immunodeficiency virus (HIV), can respond to alitretinoin in as little as 2 weeks, but most people do not start to see results for 48 weeks or, in some cases, 14 weeks or more.
Cautions and Warnings
Do not use alitretinoin if you are allergic or sensitive to retinoids or to any of its ingredients.
Alitretinoin is applied to individual KS lesions. It does not treat systemic KS or prevent new KS lesions from forming.
People requiring systemic KS treatment (those who have developed more than 10 new KS lesions within a month) should not use alitretinoin.
People with swollen lymph glands, KS that affects the lungs or other major organ involvement should not use alitretinoin.
Possible Side Effects .
✓ Most common: rash and burning pain at application site.
♦ Common: itchy, flaking, peeling, cracking, oozing, swelling, and inflammation at application site.
Drug Interactions
• Do not use insect repellant products that contain DEET, a widely used chemical repellant. Alitretinoin increases DEET toxicity.
Usual Dose
Adult: Apply 2-4 times a day to KS skin lesions. Seniors should use this drug with caution.
Child: not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Apply enough alitretinoin gel to cover the entire skin lesion. Allow the gel to dry for 3-5 minutes before covering the area with clothing. Avoid showering, bathing, or swimming for at least 3 hours.
If you use a bandage or dressing, be sure it is not tight and that air can circulate freely over the area.
Avoid applying alitretinoin to unaffected skin because it may be irritated by the drug. Avoid applying near the nose, eyes, or mouth.
Alitretinoin contains alcohol. Always keep it away from any open flame.
Retinoids can cause unusual sensitivity to the sun. While this has not been seen with alitretinoin, you should avoid prolonged exposure to the sun or use sunscreen while taking this drug.
If you forget a dose, apply it as soon as you remember. If it is almost time for your next dose, apply the forgotten dose and then space the rest of your doses throughout the day. Continue with your regular schedule the next day.
Special Populations
PregnancylBreast-feeding., Alitretinoin can harm the fetus when sufficient levels of the drug are present in the mother’s bloodstream, but it is not known if these levels are achieved during routine use of alitretinoin. Women who are or might be pregnant should only use this drug after discussing its potential benefits and risks with their doctors.
It is not known if alitretinoin passes into breast milk. Nursing mothers who must use alitretinoin should use infant formula.
Seniors: There is no information on use of alitretinoin by seniors. Seniors should use it with caution.
Jul
16
Acyclovir
July 16, 2009 | Leave a Comment
Generic Name
Acyclovir
Brand Name Zovirax
Type of Drug Antiviral.
Prescribed For
Initial treatment and maintenance of genital herpes outbreaks; treatment of herpes zoster (shingles); and treatment of varicella (chickenpox).
General Information
Acyclovir is the only oral drug that reduces growth rates of the herpes virus and the related viruses, Epstein-Barr, varicella, and cytomegalovirus (CMV); both oral acyclovir and oral ganciclovir work against CMV Intravenous drugs, including acyclovir injection, may also be used for these viral infections; however, intravenous antiviral drugs are usually reserved for patients with HIV, cancer, or otherwise compromised immune systems.
Acyclovir is selectively absorbed into cells that are infected with the herpes simplex virus, where it is converted into its active form. Acyclovir works by interfering with the reproduction of viral DNA, slowing the growth of existing viruses. It has little effect on recurrent infections. To treat both local and systemic (whole-body) symptoms acyclovir must be given by intravenous injection or taken by mouth. Local symptoms may be treated with the ointment alone. Oral acyclovir may be taken every day to reduce the number and severity of herpes attacks in people who suffer 10 or more attacks a year; it may also be used to treat intermittent attacks as they occur, but treatment must be started as soon as possible to have the greatest effect.
Cautions and Warnings
Do not use acyclovir if you are allergic or sensitive to any of its ingredients. Do not use acyclovir ointment if you have had an allergic reaction to it or to the major component of the ointment base, polyethylene glycol. Do not apply acyclovir ointment inside the vagina because the polyethylene glycol base may cause irritation and swelling of sensitive vaginal tissue. Acyclovir ointment is not intended for use in the eye and should not be used to treat a herpes infection of the eye.
Renal failure has occurred in patients using oral acyclovir, in some cases resulting in death. People with kidney impairment should have dosages adjusted accordingly.
Maintain adequate hydration while taking oral acyclovir. Animal testing indicates that acyclovir may affect fertility in men. These effects may be reversible.
Possible Side Effects
Capsules, Suspension, and Tablets
✓ Most common: feeling unwell, headache, diarrhea, nausea, and vomiting.
✓ Less common: appetite loss, stomach gas, constipation, fatigue, rash, leg pains, sore throat, a bad taste in the mouth, sleeplessness, and fever.
♦ Rare: aching joints, weakness, and tingling in the hands or feet. Contact your doctor if you experience any side effect not listed above.
Ointment
✓ Most common: mild burning, irritation, rash, and itching. These effects are more likely to occur when treating an initial herpes attack than a recurrent attack. Women are 4 times more likely to experience burning than men.
Drug Interactions
• Do not apply acyclovir together with any other ointment or topical medication.
• Oral probenecid may decrease elimination of acyclovir from the body, which increases blood levels of oral or injected acyclovir, increasing the risk of side effects.
• Combining acyclovir and zidovudine (an HIV drug—also known as AZT) may lead to severe drowsiness and lethargy.
Food Interactions
Acyclovir may be taken with food if it upsets your stomach.
Usual Dose
Capsules, Suspension, and Tablets
Adult: genital herpes attack-200 mg every 4 hours, 5 times a day for 10 days. Recurrent infections-400 mg 3 times a day or 200 mg 5 times a day for 5 days. Suppressive therapy for chronic herpes-800 mg a day, every day for up to a year. Herpes zoster800 mg 5 times a day for 7-10 days.
Child (age 2 and over): Acyclovir has been given to children in daily doses as high as 36 mg per lb. of body weight without any unusual side effects.
Child (under age 2): not recommended.
If you have kidney disease, your doctor should adjust your dose according to the degree of functional loss.
Ointment: Apply every 3 hours, 6 times a day for 7 days. Apply enough medication to cover all visible skin lesions. About 1/2 in. of ointment should cover about 4 sq. in. of lesions. Your doctor may prescribe a longer course of treatment to prevent the delayed formation of new lesions over the duration of an attack. Begin using ointment at the first sign of an attack.
Overdosage
Overdose of oral acyclovir may lead to kidney damage due to deposits of acyclovir crystals in the kidneys. Other side effects include agitation, seizures, lethargy, and coma. The risk of experiencing toxic side effects from swallowing acyclovir ointment is quite small. In the case of overdose or accidental ingestion, call your poison control center. ALWAYS bring the prescription bottle or container.
Special Information
Use a finger cot or rubber glove when applying acyclovir ointment to protect against inadvertently spreading the virus. Be sure to apply the medication exactly as directed and to completely cover all lesions. Keep affected areas clean and dry. Loose-fitting clothing will reduce possible irritation of a healing lesion. If you skip several doses, or a day or more of treatment, the drug will not exert its maximum effect.
Acyclovir is not a cure for genital herpes. Herpes may be transmitted even if you do not have symptoms of active disease. To avoid giving the condition to a sexual partner, do not have intercourse while visible herpes lesions are present. A condom offers some protection against transmission of the herpes virus, but spermicidal products and diaphragms do not. Acyclovir alone will not prevent herpes transmission.
Initiate therapy at the first sign of symptoms.
Women with genital herpes have an increased risk of cervical cancer. Speak with your doctor about the need for an annual Pap smear.
Call your doctor if acyclovir does not relieve your symptoms, if side effects become severe or intolerable, or if you become pregnant or want to begin breast-feeding. Check with your dentist if you notice swelling or tenderness of the gums.
Avoid exposure to excessive sunlight or sunlamps because of unusual sensitivity caused by oral acyclovir.
Special Populations
Pregnancy/Breast-feeding: Acyclovir crosses into the circulation of the fetus. Animal studies have shown that large doses—up to 125 times the human dose—cause damage to both mother and fetus. While there is no information to indicate that acyclovir affects a human fetus, do not use it during pregnancy unless it is specifically prescribed by your doctor and the possible benefit outweighs the risk.
Acyclovir passes into breast milk in concentrations up to 4 times the concentration in blood, and it has been found in the urine of a nursing infant. Although no side effects have been found in nursing babies, mothers who must take acyclovir should use infant formula.
Seniors: Shingles attacks in people over age 50 tend to be more severe and respond best to acyclovir treatment if the drug is started within 48-72 hours of the appearance of the first rash. Seniors with reduced kidney function should be given a lower dose of oral acyclovir than younger adults.
Jul
2
Acne: Prescription Lotions and Gels
July 2, 2009 | Leave a Comment
Prescription Lotions and Gels for Acne Treatment
If treatment with benzoyl peroxide doesn’t get your pimples under control within a couple of months, check with a physician. Dermatologists often prescribe topical antibiotic gels or lotions in addition to or instead of benzoyl peroxide. Erythromycin and clindamycin are old standbys. Because they have been so widely used however, bacteria have begun to develop resistance to them. As a result, dermatologists have been restricting their use and instead turning to other approaches.
One other medication that is being prescribed is azelaic acid (Azelex, Finevin). Like benzoyl peroxide, this topical treatment seems to keep pores from clogging and to discour-age the multiplication and spread of bacteria. It too may result in burning, stinging, redness, or dryness of the skin. In rare instances, dark skin exposed to azelaic acid may develop lighter patches. If you have a cold sore or fever blister that gets worse while you are using an azelaic acid product, notify the prescribing physician immediately.
Isotretinoin or a similar compound in the vitamin A family can be very effective in treating acne and reducing the inflammation associated with severe acne. Using topical vitamin A–like compounds (retinoids) early in the course of acne lessens the likelihood of scarring, a complication of the condition. Some doctors prescribe tretinoin together with benzoyl peroxide or with an oral antibiotic such as doxycycline to clear the skin faster.
Clindamycin Gel (Cleocin T, Clinda-Derm, Evoclin Topical Foam
Clindamycin is an antibiotic that can be applied to the skin to fight acne-causing bacteria. It may take 2 months to see significant improvement, but generally this treatment is effective. Other topical antibiotics such as erythromycin gel are also effective. Some prescription products combine an antibiotic with benzoyl peroxide for greater effectiveness. These include BenzaClin and Duac Gel (clindamycin plus benzoyl peroxide) and Benzamycin (erythromycin plus benzoyl peroxide). These are effective but expensive because no generic equivalents are available.
Side effects: Itching, burning, dryness, and peeling. A rare but very serious and dangerous side effect of clindamycin that is extremely unlikely to occur but still possible with the topical form is pseudomembranous colitis. Notify your doctor immediately if you develop persistent or bloody diarrhea.
Downside: Skin bacteria (P. aches) are beginning to develop resistance to topical clindamycin.
Cost: Approximately $50 for a 60-gram tube Tretinoin Gel (Retin-A).
Retin-A speeds up cell turnover and normalizes the lower levels of the skin. With 6 weeks or more of treatment, it is frequently very helpful against acne.
Side effects: Stinging, dryness, redness, flaking, and irritation.
Downside: Retin-A makes skin more sensitive to sunburn and sun damage, so stay out of the sun and use effective protection against ultraviolet rays.
Cost: $35 to $50 for 15 grams.
There is another prescription gel or cream that is based on a vitamin. Nicomide-T gel or cream contains nicotinamide, a form of niacin. Like Retin-A, it is topical but not an antibiotic, so theoretically bacteria should not develop resistance to it. A preliminary study showed that Nicomide-T gel is as effective as clindamycin gel in reducing blemishes.” Other research confirmed that it can protect the skin and is less likely to dry it than a number of other acne treatments. It is not clear whether Nicomide-T is as effective as Retin-A, though some studies conducted by the manufacturer, Sirius Laboratories, suggest that adding it to other treatments boosts the effectiveness of both.