Proton Pump Inhibitors - Drug

Type of Drug

Proton pump inhibitors (PPls); gastric (stomach) acid secretion inhibitors.

How The Drug Works

PPls reduce gastric acid secretion significantly and for a prolonged period by blocking the final step of acid production by the stomach lining.

Uses

For short-term treatment (8 weeks or less) of gastroesophageal reflux disease (GERD, the reflux of stomach contents into the food pipe, which can cause heartburn), and to maintain healing and reduce relapse rates of heartburn symptoms in patients with erosive or ulcerative GERD.

Esomeprazole, lansoprazole, omeprazole: For short-term treatment (4 to 8 weeks for esomeprazole and omeprazole; 8 weeks or less for lansoprazole) or to maintain healing of inflammation and erosion of the food pipe (erosive nsophilqitis).

Esomeprazole, lansoprazole, omeprazole, rabeprazole: In combination therapy with antibiotics for treatment and elimination of Helicobacter pylori infection and associated active duodenal ulcer and to reduce the risk of ulcer recurrence.

Lansoprazole: For short-term treatment (up to 12 weeks) to reduce the risk of NSAID-associated gastric ulcers.

Lansoprazole, Omeprazole: For short-term treatment (4 to 8 weeks for omeprazole; 8 weeks or less for lansoprazole) of active benign gastric ulcers; to treat and reduce the risk of gastric ulcers associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (Iansoprazole only).

Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole: For long-term treatment of hypersecretory (increased acid secretion) conditions (eg, Zollinger-Ellison syndrome).

Lansoprazole, Omeprazole, Rabeprazole: For short-term treatment (4 to 8 weeks for omeprazole; 4 weeks or less for lansoprazole, rabeprazole) of active duodenal ulcers; to maintain healing of duodenal ulcers (Iansoprazole only).

Other Uses: These agents may increase the effectiveness of pancreatic enzyme replacements used to treat the "fatty stools" of patients with cystic fibrosis. Omeprazole has been prescribed to treat laryngitis.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits out weigh the possible risks to the fetus.

Breastfeeding: It is not known if proton pump inhibitors are excreted in breast milk. Because of the potential for serious adverse reactions in nursing infants from PPI, decide whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Omeprazole can be used in children 2 years of age and older.

Safety and effectiveness of other agents have not been established.

Drug Interactions

Tell your doctor or pharmacist if you are taking or planning to take any over ­ the-counter or prescription medications or dietary supplements with these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

Ampicillin (eg, Principen)

Clarithromycin (eg, Biaxin)

Benzodiazepines (eg, diazepam)

Cyclosporine (eg, Neora/)

Disulfiram (eg, Antabusn)

Iron salts (eg, ferrous sulfate)

Phenytoin (eg, Dilantin)

Sucralfate (eg, Carafate)

Side Effects

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Diarrhea; nausea; vomiting; stomach pain; constipation; gas; belching.

Nervous System: Dizziness; headache; weakness.

Other: Rash; back pain; upper respiratory tract infection; cough; high blood sugar.

Guidelines for Use

Dosage is individualized. Take exactly as prescribed.

Do not stop takingor change the dose, unless instructed by your doctor.

Usually taken once daily, at least 1 hour before a meal. Dosages and dosing regimens may vary depending on condition being treated.

Take rabeprazole after the morning meal when treating duodenal ulcers.

Take pantoprazole with or without regard to food.

There medicine must be taken daily to be effective in treating and preventing acid-related gastrointestinal diseases. Do not take on an "as needed" basis.

Antacids may be used as needed with these medicines.

Do not chew, crush, or split capsules or tablets. Swallow whole. If you have difficulty swallowing esomeprazole, omeprazole, or lansoprazole capsules, they maybe opened, sprinkled on 1 tablespoon of apple sauce, Ensure pudding, cottage cheese, yogurt, or strained pears, and swallowed immediately without chewing the granules. Lansoprazole capsules can also be emptied into a small glass of either orange or tomato juice (60 ml; approximately 2 oz), mixed briefly, and swallowed immediately. To ensure complete ingestion, rinse the glass with 4 or more oz of juice and swallow the cOntents immediately.

Orally-disintegrating tablets - Place tablet on the tongue. Allow to melt with or without water until particles can be swallowed.

Lansoafazole suspension - Empty the packet contents into a container with 2 tablespoons (30 ml) of water. Do not use other liquids or foods. Stir well and drink immediately. More water can be added if material remains in the container; drink immediately.

If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.

Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.

PPls should be taken at least 30 minutes prior to taking sucralfate.

Store at controlled room temperature (59° to 86°F) in a tightly closed container. Protect from light and moisture.

Author has an experience of more than 4 years writing about drug interactions He also holds experience writing about benefits of drugs and side effects of drugs

Gallstone Dissolving Agents - Oral Drug

Type of Drug

Gallstone dissolving agent.

How the Drug Works

Ursodiol helps dissolve cholesterol gallstones. It is most effective if the gallstones are small or "floatable." Patients must have a working gallbladder.

Uses

To dissolve cholesterol gallstones smaller than 20 mm in diameter in patients who are not good candidates for surgery because of systemic disease, advanced age, or reaction to general anesthesia.

For the prevention of gallstones in obese patients experiencing rapid weight loss.

Gallstone Recurrence: Treatment requires months of therapy. Complete dissolution does not always occur and recurrence with in 5 years has been observed in 50% or fewer patients. Consider alternative therapy if possible.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if ursodiol appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established.

Lab tests will be required during treatment. Tests include liver function; analysis.

Drug Interactions

Tell your doctor or pharmacist if you are taking or planning to take any over ­ the-counter or prescription medications or dietary supplements with this drug. Drug doses may need to be modified or a different drug prescribed.

The following drugs and drug classes interact with this drug:

Antacids, Aluminum-based (eg, aluminum hydroxide)

Clofibrate (eg, Atromid-S)
Contraceptives, Oral (eg, Ortho-Novum)
Bile Acid Sequestrants (eg, cholestyramine)
Estrogens (eg, ethinyl estradiol)

Side Effects

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include.

Digestive Tract: Nausea; vomiting; diarrhea; severe abdominal pain (especially in upper right side); indigestion; constipation; gas; gallbladder inflammation; inflammation of the mouth.

Nervous System: Headache; fatigue; anxiety; depression; sleep problems.

Skin: Rash; itching; hives; dry skin; sweating; hair thinning.

Other: Metallic taste; joint and muscle pain; cough; runny nose; back pain; mouth sores.

Guidelines for Use

Use exactly as prescribed. Otherwise, the gallstones may dissolve very slowly or not at all.

If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose in order to "catch up" (unless advised to do so by your doctor). If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.

Carefully follow the diet your doctor has prescribed.

Contact your doctor if diarrhea, stomach pain, severe sudden pain in upper right side, nausea or vomiting occurs.

Therapy usually takes months. Complete dissolving of gallstones does not occur in all patients, and recurrence within 5 years occurs in up to 50% of patients.

The long-term effects (more than 24 months) of this medicine are not known.

Lab tests will be required to monitor therapy. Be sure to keep appointments.

Store below 86°F.

Do you wish to know more about drugs treatment or guidelines for using drugs? Then have a look at authors site on which you will also find drug prevention

Are ProDrugs the Next Generation of ADHD Medications?

Just as 2006 and 2007 saw an increase options for delivery systems of medications for ADHD, the next generation of medications for ADHD may be just around the corner in 2008 and 2009. These NextGen medications are known as ProDrugs, and they have the potential to change the way medications are prescribed to individuals with ADHD.

Since there has been a recent explosion of new ADHD drugs such as Strattera, or new delivery systems such as Daytrana, or "old drugs in new dresses" such as Concerta, why in the world is it necessary to develop any more new drugs for ADHD? Why should we care?

ProDrugs: The Next Generation of ADHD Medications

To the extent that new drugs are just "old drugs in new dresses" for a pharmaceutical company to make money, we don't care. But to the extent that this NextGen of ProDrugs might actually make a difference in people's lives, we are very interested in learning more.

And given that between 30% and 40% of patients cannot tolerate the side-effects of current stimulant medications, and given that today's ADHD medications range from about 60% effective (Strattera) to 80% effective (Ritalin), there is a lot of room for improvement in this field. This is why we like Attend, which is not a drug, but is about 70% effective and with few or no side-effects. It is just not well known.

By developing this next generation of drugs, pharmaceutical companies are betting huge sums of monies that they can develop ADHD drugs that are more efficient for a given individual, and with fewer side-effects. Since there are different types of ADHD, different types of drugs, or drugs that will work on different parts or systems of the brain, will be more efficient than just broad acting CNS stimulants.

What is a ProDrug?

A ProDrug is an inactive precursor of another drug, an inactive precursor to a particular pharmacologic agent. It is a drug that is given in an inactive, or greatly less active form. But once taken, the person's body metabolizes it into an active form. The person's body becomes the "delivery system."

A ProDrug is designed to be more efficient in treatment, by being better absorbed and better utilizied by the body, with less side-effects.

The goal of ProDrugs is for the drug to be highly targeted to a specific system or region of the body, a specific site of action, rather than just impact the entire body or CNS.

Shire Pharmaceuticals, a company that we have been very critical of in the past, is one of the companies leading the way in ProDrug development. Well, actually they are not, but they did by New River Pharmaceuticals for $2,600,000,000 (yes, that is 2.6 Billion dollars). And New River Pharmaceuticals was leading the lay in ProDrug development for ADHD with their drug Vyvanse (lisdexamgetamine dimesylate). The FDA approved Vyvanse as a "novel treatment" for ADHD in February of 2007, and the DEA will classify it as a Schedule II controlled substance.

From the Shire press release of Feb. 2007:

"VYVANSE is a prodrug that is therapeutically inactive until metabolized in the body. In clinical studies designed to measure duration of effect, VYVANSE provided significant efficacy compared to placebo for a full treatment day, up through and including 6:00 pm. Furthermore, when VYVANSE was administered orally and intravenously in two clinical human drug abuse studies, VYVANSE produced subjective responses on a scale of "Drug Liking Effects" (DLE) that were less than d-amphetamine at equivalent doses. DLE is used in clinical abuse studies to measure relative preference among known substance abusers.

"The FDA approval of VYVANSE is exciting news for Shire as well as for patients, their families, and healthcare providers as it's an important, novel approach for the treatment of ADHD," said Matthew Emmens, Shire Chief Executive Officer. "The label we received with the approval letter includes information about the extended duration of effect and abuse-related drug liking characteristics of VYVANSE which illustrate benefits that differentiate this compound from other ADHD medicines. The addition of VYVANSE to our ADHD portfolio reaffirms Shire's commitment to continue to address unmet medical needs and advance the science of ADHD treatment. Beginning with product launch in Q2 2007, Shire will make VYVANSE our top promotional priority within our ADHD portfolio."

The big selling point of Vyvanse is that it may reduce the potential for abuse, as ProDrugs are not favored by those intending to abuse stimulants.

In regards to ADHD ProDrugs, admittedly Vyvanse is the only ProDrug that I have heard any lectures on or read anything about, but I don't want to assume that it is the only ProDrug in development for ADHD. In the studies on Vyvanse, the researchers found that among all of the subjects, the ProDrug was metabolized very consistently in terms of time to optimum therapeutic levels in the body, and in terms of the predictability of the degree to which the ProDrug was utilized by the body.

To put it better, put ten kids in a room who each weigh 100 pounds. Let's say that they each need treatment with methylphenidate (Ritalin, et al.). The variety of optimal doses in those ten children could range from 5mg per dose to 40mg per dose. But with the ProDrug, the study indicates that nearly everyone of that body weight will be taking the same size does to get the optimum dose.

To put it even more simply, it will be easier for doctors who aren't paying attention well to get the right dose for the right child the first time. And the response to the drug will be more predictable. Everything will operate more efficiently with a more efficient drug.

To learn more about medication and treatment for ADHD, or to learn more about attention deficit hyperactivity disorder visit http://newideas.net for the ADHD Information Library. This information is not to be considered medical advice, but is for information only. Consult your physician.