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rx.umaryland.edu

OBJECTIVE: To split several tablet products relevant to the Veterans Affairs (VA) Maryland Healthcare System and assess whether the resulting half tablets provide equal doses. METHODS: From a VA list of products that are required to be split, 7 products were evaluated, along with 5 other commonly split tablet products. A trained pharmacy student split tablets using a tablet splitter provided by the VA. Half tablets were assessed for weight uniformity. RESULTS: Of the 12 products subjected to splitting, 8 products (atorvastatin, citalopram, furosemide, glipizide, metoprolol, paroxetine, sertraline, and warfarin) yielded half tablets that passed the weight-uniformity test. The 4 failing products were lisinopril, lovastatin, rofecoxib, and simvastatin. Unusual tablet shape and high tablet hardness predisposed products to failing the weight-uniformity test. The 4 failing products resulted in half tablets that were generally within 20% of their target weight range, suggesting that splitting these specific products would not result in adverse therapeutic effects due to dose variation created by tablet-splitting. CONCLUSION: Split-tablet results were relatively favorable and generally support a VA practice to split specific tablets. Public quality standards for half tablets, including their content uniformity, are needed to better delineate the policies for acceptable tablet splitting.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14613437&dopt=Abstract




J Manag Care Pharm. 2003 Sep-Oct;9(5):424-9.
Patient adherence with amlodipine, lisinopril, or valsartan therapy in a usual-care setting.

Wogen J, Kreilick CA, Livornese RC, Yokoyama K, Frech F.

The Institute for Effectiveness Research, LLC, 520 U.S. Highway 22, Suite 303, Bridgewater, NJ 08807, USA.

OBJECTIVE: To compare the persistence and compliance in a usual-care setting with 3 drugs (amlodipine, lisinopril, or valsartan) from 3 different pharmaceutical classes.calcium-channel blocker, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker, respectively, commonly used to treat hypertension. METHODS: This retrospective observational study included a cohort of 142,945 continuously benefit-eligible patients from a pharmacy benefit manager drug claims database who began therapy with lisinopril, valsartan, or amlodipine. Concurrent use of other cardiovascular medications was assessed as a proxy for cardiovascular disease severity. Chronic Disease Score (CDS), derived from pharmacy claims data, was used to classify patient chronic disease burden as mild, moderate, or severe. Drug utilization measures included compliance, persistence, medication possession ratio (MPR), duration of therapy, and drug discontinuation. Multiple linear regression techniques were used to assess the impact of various predictor variables on study outcomes and to compare compliance among treatment groups, adjusted for age, gender, and CDS. RESULTS: The mean age of the study cohort was 63.1 years; 53% were female. Just over one half (51%, n=73,148) received amlodipine, 28% (n=40,238) received lisinopril, and 21% (n=29,669) received valsartan. Significantly more valsartan patients (63%) remained persistent on therapy at 12 months past the index date of the first prescription, compared with amlodipine (53%) and lisinopril (50%) patients (P<0.001). Both crude and adjusted compliance rates also were greatest for valsartan patients, reflected by an adjusted mean MPR of 75%, compared with 67% for amlodipine and 65% for lisinopril (P<0.0001, both comparisons). CONCLUSION: These results suggest that, in a usual-care setting, patients receiving valsartan (relative to amlodipine or lisinopril) appear to be more compliant and persistent with pharmacologic therapy, independent of patient chronic disease burden.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14613440&dopt=Abstract

univ-angers.fr

This study was designed to demonstrate potential beneficial as well as detrimental effects of lisinopril and spironolactone given in combination. In patients with congestive heart failure or myocardial infarction, the use of angiotensin-converting enzyme (ACE) inhibitors may inhibit aldosterone production. Spironolactone, a specific aldosterone receptor antagonist may exert other independent and additive effects to those of ACE inhibitors. Given the consequences of aldosterone on ischemic hearts, we evaluated the protective effects of spironolactone or lisinopril and combined spironolactone-lisinopril therapy during low-flow ischemia and reperfusion in isolated rat hearts. Normal and infarcted (left coronary artery ligature) male Wistar rats were submitted to chronic action of drugs (0.8 mg.kg-1.day-1 for lisinopril and 8 or 50 mg.kg-1.day-1 for spironolactone) for 1 month. Hearts were rapidly excised and perfused (constant pressure) for a 40-min period of stabilization followed by a 25-min period of global low-flow ischemia and a 30-min reperfusion. In normal rats, spironolactone decreased ischemic and reperfusion contracture, reduced ventricular tachycardia, suppressed action-potential duration dispersion, and increased reactive hyperemia leading to an improvement of contractile recovery. Lisinopril also decreased ventricular tachycardia and action-potential duration dispersion concomitantly with increased reactive hyperemia and better contractile recovery. These beneficial effects of the drugs were lost when the two treatments were combined (lisinopril and 50 mg.kg-1.day-1 spironolactone), despite a synergistic effect on plasmatic K+ and Mg2+. However, an interaction between the ACE inhibitor and spironolactone potentiating the effects of either drug alone was observed with a lower dose of spironolactone (lisinopril and 8 mg.kg-1.day-1 spironolactone). Similar beneficial effects have been noted in infarcted rat hearts on reactive hyperemia, ventricular tachycardia, and contractile recovery with the combined treatment and for both spironolactone concentrations (8 or 50 mg). Chronic spironolactone treatment produces similar beneficial effects to ACE inhibitor treatment on normal rat hearts during an ischemia-reperfusion protocol. Synergistic effects have been observed with the combined therapy when a lower dose of spironolactone was utilized in normal and infarcted rats. However, in the case of a high dose of spironolactone, the two effective drugs seem to cancel each other but only in normal rats.

online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14614522&dopt=Abstract [PubMed - in process]





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