Drugs online research references
Ann Pharmacother. 1992 Mar;26(3):399-404.
Enalapril to lisinopril: economic impact of a voluntary angiotensin-converting enzyme-inhibitor substitution program in a staff-model health maintenance organization.
McDonough KP, Weaver RH, Viall GD.
Harvard Community Health Plan of New England, Providence, RI 02903.
OBJECTIVE: The cost-effectiveness of a voluntary program that switched enalapril to lisinopril therapy in patients with benign essential hypertension in a staff-model health maintenance organization (HMO) was evaluated. DESIGN: The one-year nonrandomized, controlled trial was performed from November 1989 through October 1990. PARTICIPANTS: One hundred twenty-seven patients were entered into the study: 75 who converted from enalapril to lisinopril and 52 who remained on enalapril throughout the study period. Patients were excluded from analysis because of diagnosis (not benign essential hypertension) or insufficient data collection. INTERVENTIONS: Patients taking enalapril were asked by staff pharmacists if they were willing to consider switching from enalapril to lisinopril. To encourage patients, the HMO agreed to waive the drug rider copayment for three months. If patients were willing, their physicians were contacted and they established the lisinopril dosage. MAIN OUTCOME MEASURES: Total direct cost and savings resulting from converting patients from enalapril to lisinopril were measured and compared with costs of therapy for patients who remained on enalapril. RESULTS: The control and study groups were evenly matched according to demographics and concomitant drug therapy. Drug acquisition costs, costs associated with waiving drug rider copayment, pharmacy administrative costs, costs of managing adverse events, costs of visits to physicians, and laboratory test costs were assessed. Depending on the cost of capital assumed, net savings ranged from $85 to $110 per patient converted from enalapril to lisinopril. Monthly net savings that ranged from $2.04 to $2.61 per patient were required to result in overall net savings within the first two years. CONCLUSIONS: In a regular practice setting, a net savings is realized in less than 12 months when patients are converted from enalapril to lisinopril for treatment of benign essential hypertension. The voluntary therapeutic interchange program provided a good means for achieving cost controls for pharmacy expenses.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1313320&dopt=Abstract
Clin Sci (Lond). 1990 Oct;79(4):393-401.
Regional haemodynamic effects of captopril, enalaprilat and lisinopril in conscious water-replete and water-deprived Brattleboro rats.
Muller AF, Gardiner SM, Compton AM, Bennett T.
Department of Medicine, University Hospital, Nottingham, U.K.
1. The regional haemodynamic effects of intravenous bolus doses of captopril, enalaprilat and lisinopril were assessed in conscious Brattleboro (i.e. vasopressin-deficient) rats, chronically instrumented with miniaturized pulsed Doppler probes and intravascular catheters. 2. Responses to incremental doses of each drug (spanning the median effective dose for the inhibition of the pressor response to angiotensin I) were examined in both water-replete and water-deprived states. 3. In the water-replete state, the haemodynamic profiles of captopril, enalaprilat and lisinopril were generally similar, with incremental doses causing rises in mesenteric and renal flow and, to a lesser extent, hindquarters flow. There were small tachycardias and only slight falls in mean blood pressure. 4. In the water-deprived state, the effects of all three drugs were greatly enhanced; tachycardic and hypotensive effects occurred together with increases in mesenteric, renal and hindquarters flows. However, for renal flow and renal vascular conductance the effectiveness of the drugs decreased in the order enalaprilat greater than captopril greater than lisinopril, whereas for mesenteric flow and mesenteric vascular conductance the order was captopril greater than enalaprilat greater than lisinopril. 5. Since marked haemodynamic actions were seen with doses one-tenth of the median effective dose for the inhibition of the pressor effect of angiotensin I, it is likely these effects were due to inhibition of angiotensin-converting enzyme, although not necessarily to inhibition of angiotensin II production.(ABSTRACT TRUNCATED AT 250 WORDS)
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2171862&dopt=Abstract
Cardiovasc Drugs Ther. 1993 Apr;7(2):193-206.
Long-term hemodynamic effects at rest and during exercise of newer antihypertensive agents and salt restriction in essential hypertension: review of epanolol, doxazosin, amlodipine, felodipine, diltiazem, lisinopril, dilevalol, carvedilol, and ketanserin.
Omvik P, Lund-Johansen P.
Department of Cardiology, Haukeland Hospital, Bergen, Norway.
Hypertension is due to disturbance of the complex interplay between numerous known and unknown mechanisms that normally control blood pressure. Antihypertensive agents may, therefore, reduce blood pressure through widely different actions and, at the same time, elicit counterregulatory responses. This is a review of the long-term hemodynamic effects at rest as well as during exercise of nine relatively new antihypertensive compounds: a beta-blocker (epanolol), an alpha-receptor blocker (doxazosin), two double-acting compounds (dilevalol and carvedilol), three calcium antagonists (amlodipine, felodipine, and diltiazem), an angiotensin-converting enzyme inhibitor (lisinopril), a serotonin antagonist (ketanserin), and low-salt diet as a nonpharmacological treatment in 171 patients with mild to moderate essential hypertension. The results in the treatment groups are compared to the hemodynamic changes seen in 28 hypertensive patients left untreated for 10 years. The patient populations of the different groups were comparable. The invasive hemodynamic technique, including intraarterial blood pressure recording and measurements of cardiac output by Cardigreen, was the same in all studies. While blood pressure remained nearly unchanged in the untreated group, all antihypertensive compounds induced significant and sustained blood pressure reduction both at rest and during exercise. The modest reduction (3-5%) in blood pressure during a low-salt diet was also statistically significant. This review shows the multiplicity of the long-term hemodynamic changes, ranging from a reduction in cardiac output to peripheral vasodilatation, during chronic antihypertensive therapy. In untreated hypertensives, the cardiac output is reduced by 1-2% per year and total peripheral resistance is increased by 2-3% per year. The review also focuses on counterregulatory responses and modify the initial reduction in blood pressure after drug treatment for hypertension. It is concluded that proper understanding of the hemodynamic effects of antihypertensive agents is useful in the selection of the right treatment for specific groups of hypertensive patients.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8395198&dopt=Abstract
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