So, considering the bulk of my last posts have been oriented towards my travels, I felt it was time to show my nerdy side again.
There has been some interesting things that have been happening in the world of pharmacy that have gotten me excited. I will start with the most recent piece of news, the pulling of propoxyphene from the US drug market.
Really, it is no surprise. Based on what we have learned in school, I am surprised it hasn’t been pulled earlier. Maybe it was something about its limited effectiveness, associated heart issues, and being on the beers list (a list of drugs that shouldn’t be used in the elderly, the main group still using propoxyphene). According to the news articles, back in January the FDA voted 14-12 in favor of keeping the drug in favor or waiting for new studies to be conducted on cardiac issues, while a box warning was added. So an initial trial was established to test the drug in healthy volunteers to establish an appropriate dose in a large scale cardiac trial. Turns out all they needed was the first trial, normal doses in healthy volunteers caused QT prolongation (a change in the electrical conduction of the heart that can lead to serious problems).
Propoxyphene 1957 – 2010
But it isn’t all death in the world of pharmaceuticals. This last month welcomed the first new class of oral anti-coagulant since warfarin. Dabigtran is some pretty exciting stuff. Warfarin is the standard anti-coagulant for most patients that need it. Of course being the standard doesn’t make it easy. Considering its narrow therapeutic window and many drug/food/activity interactions makes it a pain to work with. Constant monitoring and life changing habits complicate warfarin therapy. Until now, for people with moderate to high risk, the only other option may have been injecting themselves, which isn’t preferred. Dabigatran is going to change that. It has a simple dose of 150 mg twice daily in most patients (75 mg twice daily in patients with severe kidney problems). A few problems though that I have seen. The RE-LY study test 110 mg twice daily being equally effective in warfarin in preventing strokes, and a lower chance of bleeding. The approved FDA strength of 150mg was superior to warfarin with an equal chance of bleeding. I guess its a trade off. The other big drawback I have noticed is that it isn’t reversible like warfarin. If someone overdosed on warfarin a dose of vitamin K in time would reverse nay issues, in dabigatran case, the only option is dialysis.
The final news is quiet interesting. Statins, some of the best selling drugs of all time, are used to combat high LDL, or bad, cholesterol. Up until recently, nothing could challenge a statin’s ability to reduce the artery clogging goop. As of right now anacetrapib has produced a 36% decrease in LDL (close to the recommended 40% for high risk individuals) while providing an astonishing 133% increase in HDL, or good, cholesterol. We will have to wait and see what the clinical impact in people with HDL’s potentialy above 100.
Ok. So, of course there is so much else going on, but I can only be so nerdy.