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Alsaadi T, Almadani A, Al-Hashel J, Al Salti A, Melikyan G, Khan RA. Commentary: Consensus Guidelines on the Appropriate Use of Brand-Name and Generic Anti-Seizure Medication for the Management of Epilepsy in the Gulf Region. Neurol Ther 2023; 12:1015-1031. [PMID: 37222860 PMCID: PMC10310631 DOI: 10.1007/s40120-023-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The clinical, social, and economic burden of epilepsy is undeniable. Local guidance on epilepsy management is limited and needed to address the both use of anti-seizure medication (ASM) and switching practices which influence clinical outcomes. AREAS COVERED An expert panel composed of practicing neurologists and epileptologists from countries of the Gulf Cooperation Council (GCC) met in 2022 to discuss local challenges in the management of epilepsy and formulate recommendations for clinical practice. Published literature on the outcomes of ASM switching was reviewed along with clinical practice/gaps, international guidelines, and local treatment availabilities. EXPERT OPINION Improper ASM use and inappropriate brand-name-to-generic or generic-to-generic switching can contribute to worsening clinical outcomes in epilepsy. ASMs should be used for the management of epilepsy based on patient clinical profile, underlying epilepsy syndrome, and drug availability to ensure optimal and sustainable treatment. Both first-generation and newer ASMs can be considered; appropriate use is recommended from the beginning of treatment. It is critical to avoid inappropriate ASM switching to avoid breakthrough seizures. All generic ASMs should fulfill strict regulatory requirements. If needed, ASM changes should always be approved by the treating physician. ASM switching (brand-name-to-generic, generic-to-generic, generic-to-brand-name) should be avoided in epilepsy patients who have achieved control but can be considered for those uncontrolled on current medication.
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Affiliation(s)
- Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | | | - Jasem Al-Hashel
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Gayane Melikyan
- Neurology, Weill Cornell Medical College-Qatar (WCMC-Q), Ar-Rayyan, Qatar
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Rajakrishnan R, Alfarhan AH, Al-Ansari AM, Lekshmi R, Sreelakshmi R, Benil PB, Kim YO, Tack JC, Na SW, Kim HJ. Therapeutic efficacy of the root tubers of Aconitum heterophyllum and its substitute Cyperus rotundus in the amelioration of pylorus ligation induced ulcerogenic and oxidative damage in rats. Saudi J Biol Sci 2019; 27:1124-1129. [PMID: 32256174 PMCID: PMC7105654 DOI: 10.1016/j.sjbs.2019.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 11/23/2022] Open
Abstract
The phenomenal increase in the demand of herbal drugs, leads to over exploitation of medicinal plants which ultimately resulted in the scarcity and endangerment of many valuable plant species. On observing the difficulties in procuring genuine herbal drugs arose the concept of substitution which was documented in many classical Ayurvedic texts. The present study made a comparative evaluation of the gastroprotective potential of hydroalcoholic extracts of an original drug Aconitum heterophyllum (HAAH) and its substitute Cyperus rotundus (HACR) in the treatment of gastric ulcer under in vivo experimental conditions. The anti-ulcer property of the plant extracts was investigated against pylorus ligation induced ulcer in Wistar albino rats. The results confirmed that both A. heterophyllum and C. rotundus deliver comparable significant protection against gastric ulcer, indicated by a decrease in the free and total acidity, volume of gastric content, total proteins and increase in pH of gastric content, total carbohydrates and total carbohydrates to total proteins ratio. The observed anti-ulcer potential of both the drugs is attributed mainly to prevention of the generation of damaging free radical cascades and oxidant radical release.
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Affiliation(s)
- R Rajakrishnan
- Dept. of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh, Saudi Arabia
| | - A H Alfarhan
- Dept. of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh, Saudi Arabia
| | - A M Al-Ansari
- Dept. of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh, Saudi Arabia
| | - R Lekshmi
- Dept. of Botany and Biotechnology, MSM College, Kayamkulam, Kerala, India
| | - R Sreelakshmi
- Dept. of Botany and Biotechnology, MSM College, Kayamkulam, Kerala, India
| | - P B Benil
- Dept. of Agadatantra, Vaidyaratnam P.S Varier Ayurveda College, Edarikode P.O., Kottakkal, Kerala, India
| | - Y-O Kim
- Department of Bio-Environmental Chemistry, College of Agriculture and Life Sciences, Chungnam National University, 99 Daehak-Ro, Yuseung-Gu, Daejeon 34134, Republic of Korea
| | - J-C Tack
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - S W Na
- The Comfort Animal Hospital, Sungbuk-gu, Soonginto-50, Seoul, Republic of Korea
| | - H-J Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
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Abstract
Oral levothyroxine (LT4) is the standard therapy for patients with hypothyroidism. Oral LT4 is available in several formulations, including tablets, soft gel capsules and oral solution. Multiple brand-name and generic LT4 tablets are available. In the US, the Food and Drug Administration (FDA) has developed a protocol for establishing bioequivalence of LT4 formulations based on serum thyroxine (T4) levels after a single oral dose administered to healthy volunteers. This protocol has been criticized by professional endocrinology associations for using healthy individuals and ignoring serum thyroid-stimulating hormone (TSH) levels. In addition, the protocol did not initially correct for baseline T4 levels, although this was changed in a later version. There are concerns that the FDA's protocol could allow products with clinically significant differences in bioavailability to be declared therapeutically equivalent and interchangeable. Once a generic LT4 has been shown to be bioequivalent to a brand-name LT4, it may be substituted for that brand-name LT4 with no need for dose adjustment or follow-up therapeutic monitoring. Often, the substitution is made by the pharmacy without the physician's knowledge. Even small differences between LT4 formulations can cause significant changes in TSH levels. This may be a particular concern in vulnerable populations, including elderly, pregnant, and pediatric patients. Problems that can be encountered when switching between formulations or when original products are reformulated are discussed in this review. These problems include altered efficacy and adverse events, some of which can be caused by excipients. Patients should be maintained on the same LT4 preparation if possible. If the LT4 preparation is changed, TSH levels should be evaluated and, if necessary, the dose of LT4 adjusted.Funding: Merck.Plain Language Summary: Plain language summary available for this article.
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Affiliation(s)
- Salvatore Benvenga
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.
- Interdepartmental Program of Molecular and Clinical Endocrinology and Women's Endocrine Health, University Hospital, AOU Policlinico G. Martino, Messina, Italy.
| | - Allan Carlé
- Department of Endocrinology and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
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Abstract
This review provides a synopsis of key clinical considerations for switching antiretroviral therapy (ART) for individuals with human immunodeficiency virus who have maintained a routinely suppressed viral load. There may be benefits but also risks involved in every ART regimen change, so strategies for prioritizing individuals for a switch based on the specific antiretroviral agents in the regimen are discussed, along with approaches to ensure maintenance of viral suppression after treatment modifications. Controversial and evolving questions in the area of ART switches and simplifications are also considered.
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Abstract
Drug shortages pose a significant public health concern in the United States, and cancer drugs are among those most affected. Shortages present serious safety risks for patients and substantial burden on providers and the healthcare system. Multifaceted drivers of this complex problem include manufacturing disruptions, raw material shortages, regulatory issues, market dynamics, and limited financial incentives that reward quality and production of off-patent drugs. Oncology drugs in short supply have resulted in substitution of less effective or more toxic alternatives, medication errors, and treatment delays, and are especially concerning for medications with no adequate substitute. Consequently, patient outcomes such as disease progression and survival have been adversely affected. Furthermore, emerging gray markets have contributed to cost-prohibitive markups and introduction of counterfeit products that compromise patient safety. The Food and Drug Administration plays a key role in preventing and managing pharmaceutical shortages, largely through regulations requiring early notification of manufacturing interruptions. Other proposed strategies similarly target upstream causes and center on reducing regulatory hurdles for manufacturers and increasing incentives for market entry and quality improvement. Despite progress in preventing supply disruptions, continued exploration of underlying systemic drivers remains critical to informing long-term solutions and alleviating the clinical and economic impact of drug shortages.
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Affiliation(s)
- Narissa J Nonzee
- Department of Health Policy and Management, University of California, Los Angeles, CA, USA.
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Lee VW, Cheng FW, Fong FY, Ng EE, Lo LL, Ngai LY, Lam AS. Branded versus generic drug use in chronic disease management in Hong Kong-perspectives of health care professionals and the general public. Hong Kong Med J 2018; 24:554-560. [PMID: 30530869 DOI: 10.12809/hkmj177087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The aim of the present study was to evaluate the understanding of generic substitution among health care professionals and members of the general public ("general public") in Hong Kong. METHODS This cross-sectional descriptive study was performed by using a self-completed anonymous questionnaire from March 2015 to May 2017. The questionnaire included demographic data, knowledge of generic drugs, experiences of generic substitution, and views on policy. RESULTS A total of 2106 general public, 73 doctors, 22 nurses, and 50 pharmacists responded the questionnaire. In all, 41.2% of the general public was aware that generic drugs have the same active ingredients. Although a majority of the health care professionals knew that generic drugs have the same active ingredients (doctors: 79.5%; nurses: 86.4%; pharmacists: 98.0%), many were unaware of bioequivalence (doctors: 37.0%; nurses: 18.2%; pharmacists: 50.0%). "Efficacy" was ranked as the primary concern among all groups; a substantial portion of respondents reported experiencing adverse drug reactions upon generic substitution (general public: 26.6%; doctors: 23.3%; nurses: 9.1%; pharmacists: 42.0%). At least half of the general public, nurses, and pharmacists considered that patients should be given a choice for generic substitution. However, fewer than one-fifth of doctors and nurses and approximately one-third of pharmacists considered that patient consent was needed prior to generic substitution, compared with approximately two-thirds of the general public. CONCLUSION The knowledge and perception of generic substitution remains low, both in the general public and among health care professionals. This knowledge deficit could potentially lead to different perspectives among stakeholders regarding generic substitution.
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Affiliation(s)
- V Wy Lee
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - F Wt Cheng
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - F Yh Fong
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - E En Ng
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - L Lh Lo
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - L Ys Ngai
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - A Sm Lam
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong
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Domeyer PJ, Katsari V, Sarafis P, Aletras V, Niakas D. Greek students' attitudes, perception and knowledge regarding generic medicines in times of economic crisis: a cross-sectional study. BMC Med Educ 2018; 18:262. [PMID: 30442145 PMCID: PMC6238271 DOI: 10.1186/s12909-018-1379-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/02/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND The penetration of generic medicines in the pharmaceutical market is influenced, among others, by the consumer's attitude upon them. The attitude of students in health management and recent alumni is particularly important, as they constitute tomorrow's policymakers. The aim of our study was to assess their attitude, perception and knowledge towards generic medicines. METHODS A cross-sectional study was undertaken, involving students in Health Management and recent alumni. The ATtitude TOwards GENerics (ATTOGEN) validated questionnaire was used, which consists of 18 items, yielding 6 scales (trust, state audit, knowledge, drug quality, drug substitution and fiscal impact), with all item responses expressed on a 5-point Likert scale and higher scores denoting greater disagreement. Correlation coefficients were computed and independent sample tests were performed using non-parametrical statistical methods. RESULTS A total of 1402 students were interviewed, with a female predominance (62.88%). The mean (SD) scores for the six scales of the ATTOGEN questionnaire were: Trust: 2.877 (0.940), State audit: 3.251 (0.967), Knowledge: 1.537 (0.688), Drug quality: 2.708 (0.971), Drug substitution: 3.828 (1.127) and Fiscal impact: 2.299 (0.860). Trust over generics was statistically significantly associated with all ATTOGEN scales (all p < 0.001). In addition, the increased level of knowledge about generics was associated with recognition of the generic medicines' quality equivalence (p < 0.001) and positive fiscal impact (p = 0.018). Pharmacists declared having a superior knowledge of generic medicines, being more satisfied with the information they receive about them and strongly believing in drug substitution (p < 0.001). Comparatively to other professionals, pharmacists also indicated substantial differences between branded and generic medicines more often (p < 0.001). They also argued to a greater extent that generic medicines were invented and promoted to resolve the financial crisis of social security institutions at the expense of citizens (p < 0.001). CONCLUSIONS This study demonstrated a mixed attitude of students regarding generic medicines. Trust and knowledge emerged as key factors shaping the students' attitude towards generics. Among students, pharmacists exhibited a distinct response pattern. This study underlines the importance of addressing and correcting health management students' misbeliefs about generics' quality and utility.
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Affiliation(s)
| | - Vasiliki Katsari
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
| | - Vassilis Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Dimitris Niakas
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece
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Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: A systematic review. Res Social Adm Pharm 2018; 14:619-627. [PMID: 28814375 PMCID: PMC5910277 DOI: 10.1016/j.sapharm.2017.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/23/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION With an increase in prescription drug spending and rising drug costs there is a need to encourage the use of generic prescription drugs. However, maximizing generic drug use is not possible without the public's positive perception and meeting their informational needs about generic drugs. Thus, improving the public's confidence in, and knowledge of generic drugs on the market is critical. The objective of this systematic review is to examine and evaluate the studies focusing on the nature and extent of key factors influencing generic drug use in the United States in order to help guide policy, education and practice interventions. MATERIALS AND METHODS Using multiple search engines and key word screening criteria, empirical studies published in English between January 1, 2005 and December 31, 2015 were identified. A qualitative synthesis of the evidence identified domains of key factors that influenced generic drug use across studies. RESULTS Over 3000 citations met the key word screening criteria; 67 of these met inclusion criteria for the systematic review. Seven domains of factors that influence generic drug utilization were identified: 1) patient-related factors, 2) formulary management or cost containment, 3) healthcare policies, 4) promotional activities, 5) educational initiatives, 6) technology, and 7) physician-related factors. CONCLUSION Patients, physicians, pharmacists, formulary managers, and policymakers play an important role in generic drug use. Understanding the factors influencing generic drug use can help guide future policy, education, and practice interventions to increase generic drug use.
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Affiliation(s)
- Jennifer N Howard
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Ilene Harris
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Gavriella Frank
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Zippora Kiptanui
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
| | - Richard Hansen
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
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Hellfritzsch M, Grove EL, Husted SE, Rasmussen L, Poulsen BK, Johnsen SP, Hallas J, Pottegård A. Clinical events preceding switching and discontinuation of oral anticoagulant treatment in patients with atrial fibrillation. Europace 2018. [PMID: 28641379 PMCID: PMC5834049 DOI: 10.1093/europace/euw241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aims Switching between oral anticoagulants and treatment discontinuation are common events related to therapy with non-vitamin K antagonist oral anticoagulants (NOACs). However, knowledge on the reasons leading to these treatment changes is scarce. The aim of this study was to identify clinical events preceding anticoagulant switching and NOAC discontinuation during oral anticoagulant therapy in patients with atrial fibrillation. Methods and results We performed a nationwide register-based study including Danish atrial fibrillation patients initiating a NOAC between August 2011 and February 2016 (n = 50 623). We explored potential reasons leading to changes in anticoagulant treatment by identifying clinical events preceding switches from vitamin K antagonists (VKA) to NOAC, switches from NOAC to VKA, and discontinuations of NOACs. Among 23 531 anticoagulant users changing treatment, we identified 13 295 switches from VKA to NOAC, 5206 switches from NOAC to VKA, and 8995 discontinuations of NOACs. Approximately half of all treatment changes were preceded by a hospitalization. A relevant specific clinical event or procedure was identified prior to 18.3% of switches from VKA to NOAC, prior to 23.0% of switches from NOAC to VKA, and prior to 26.6% of discontinuations. Switches from VKA to NOAC were most often preceded by thromboembolic events (7.0%), whereas cardioversion was the most common specific event prior to a switch from NOAC to VKA (11.4%). Discontinuations were most often preceded by bleeding events (7.6%). Conclusion For about one in five patients, treatment changes during anticoagulant therapy were preceded by a major clinical event. However, the majority of patients changed treatment for reasons not recorded in health registries.
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Affiliation(s)
- Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, DK-5000 Odense, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus, Denmark
| | - Steen Elkjær Husted
- Department of Internal Medicine, Hospital Unit West, Gl. Landevej 61, DK-7400 Herning, Denmark
| | - Lotte Rasmussen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, DK-5000 Odense, Denmark
| | - Birgitte Klindt Poulsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Bartholins Allé 4, DK-8000 Aarhus, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes allé 43, DK-8200 Aarhus, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, DK-5000 Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 19, DK-5000 Odense, Denmark
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Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. "No generics, Doctor!" The perspective of general practitioners in two French regions. BMC Health Serv Res 2017; 17:707. [PMID: 29121918 PMCID: PMC5680768 DOI: 10.1186/s12913-017-2682-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
Background Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs) toward generic medicines in two French regions with the lowest penetration rate of these products. Methods An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase. Results Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Conclusion Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.
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Affiliation(s)
- Béatrice Riner
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Adèle Bussy
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Jeannie Hélène-Pelage
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Nycrees Moueza
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Sébastien Lamy
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France
| | - Philippe Carrère
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France. .,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France. .,Département de Médecine Générale, Faculté de Médecine Hyacinthe Bastaraud, Campus Universitaire de Fouillole, Université des Antilles, 97157 Pointe-à-Pitre Cedex, Guadeloupe, BP 250, France.
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Pittenger ST, Chou S, Barrett ST, Catalano I, Lydiatt M, Bevins RA. Nicotine- and cocaine-triggered methamphetamine reinstatement in female and male Sprague-Dawley rats. Pharmacol Biochem Behav 2017; 159:69-75. [PMID: 28712749 DOI: 10.1016/j.pbb.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022]
Abstract
Preclinical studies have demonstrated a return to methamphetamine (meth)-seeking behavior (reinstatement) induced by injections of meth administered by the experimenter (drug-prime). Notably, females tend to be more sensitive to drug-prime; often displaying more reinstatement behavior when compared to males. While meth-primed reinstatement of meth-seeking behavior has been established, little is known about the ability of other drugs of abuse to substitute for meth during drug-primed reinstatement; nicotine and cocaine were the focus of the present work. We also examined if self-administration and/or reinstated meth-seeking behavior was affected by repeated nicotine administration. Male and female Sprague-Dawley rats were trained to self-administer meth during daily sessions. During this self-administration phase, rats were placed into 1 of 2 groups: saline or repeated nicotine exposure. Rats in the repeated nicotine group received nicotine injections 4h after meth self-administration sessions, whereas the remaining rats received saline. Following self-administration was extinction in which meth was no longer available and nicotine was no longer administered. After extinction, rats were tested to determine if 0 (saline), 0.2, and 0.4mg/kg nicotine reinstated meth-seeking behavior. Three days of re-extinction followed nicotine testing. Finally, rats received reinstatement tests with 0 (saline), 5, and 10mg/kg cocaine. Nicotine and cocaine reinstated meth-seeking behavior in male and female rats with no difference between the sexes. Repeated nicotine administration potentiated meth reinstatement following the 0.4mg/kg nicotine-prime. While females may be more sensitive to reinstatement triggered with the original self-administration drug, this effect may not generalize to priming with other drugs of abuse.
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Affiliation(s)
- Steven T Pittenger
- Yale University School of Medicine, Division of Molecular Psychiatry, New Haven, CT, USA.
| | - Shinnyi Chou
- University of Nebraska Medical Center, School of Medicine, Omaha, NE, USA
| | - Scott T Barrett
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, NE, USA
| | - Isabella Catalano
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, NE, USA
| | - Maxwell Lydiatt
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, NE, USA
| | - Rick A Bevins
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, NE, USA
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O'Connor G, O'Keeffe D, Darker C, O'Shea B. Patient acceptability and experiences of therapeutic switching of proton pump inhibitors within the National Preferred Drugs initiative in Ireland. Ir J Med Sci 2016; 186:631-639. [PMID: 28039598 DOI: 10.1007/s11845-016-1535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A 'Preferred Drugs' initiative was introduced into Ireland in 2013. This identified a single recommended drug to be prescribed to patients requiring treatment from a particular class of drugs. AIMS This study investigates how patients on established proton pump inhibitor (PPI) therapy experienced the therapeutic switching of their medication to the 'preferred drug', and the extent to which they regarded it as an acceptable practice. METHODS The experiences of 61 patients on established proton pump inhibitor (PPI) therapy were sought before and after their drug was switched to the 'preferred drug'. RESULTS Eighty per cent of patients were happy to switch medications. When asked for their opinions on medications in general, 71% felt doctors should prescribe the least expensive medication, 84% agreed that all licensed medications were safe while 67% felt their GP changing medication for cost reasons was safe. After 8 weeks, 20% of patients had switched back to their old PPI. When asked how they felt about their medication change, 74% felt happy or pleased. CONCLUSIONS The majority of patients in our study were satisfied to have their medication switched. However, prescribers should be mindful that 1 in 5 patients encountered problems as a result of the switching process.
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Affiliation(s)
- G O'Connor
- General Practice Registrar, Trinity College Dublin/Health Service Executive General Practice Training Scheme, Department of Public Health and Primary Care, Trinity Centre, AMNCH, Tallaght, Dublin 24, Ireland. .,Department of Public Health and Primary Care, Trinity College, Dublin, Ireland.
| | - D O'Keeffe
- General Practice Registrar, Trinity College Dublin/Health Service Executive General Practice Training Scheme, Department of Public Health and Primary Care, Trinity Centre, AMNCH, Tallaght, Dublin 24, Ireland.,Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - C Darker
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - B O'Shea
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
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Mutti A, Aroni S, Fadda P, Padovani L, Mancini L, Collu R, Muntoni AL, Fattore L, Chiamulera C. The ketamine-like compound methoxetamine substitutes for ketamine in the self-administration paradigm and enhances mesolimbic dopaminergic transmission. Psychopharmacology (Berl) 2016; 233:2241-51. [PMID: 27020786 DOI: 10.1007/s00213-016-4275-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/09/2016] [Indexed: 01/26/2023]
Abstract
RATIONALE Recently, an increasing number of emergency cases due to a novel ketamine-like drug, methoxetamine (MXE), were reported in several countries. However, very little is known about the neuropsychopharmacological and reinforcing profile of this compound. OBJECTIVES Our study aims to investigate the effects of MXE on self-administration (SA) behaviour in comparison to ketamine and on dopaminergic transmission. METHODS A SA substitution study was performed in male rats trained to intravenously (IV) self-administer ketamine. At responding stability, rats were exposed to sequential phases of MXE substitution at different dosages (starting from 0.5 and then decreasing to 0.25 and 0.125 mg/kg). Standard electrophysiological techniques were used to record changes in firing activities of ventral tegmental area (VTA) dopamine neurons projecting to the nucleus accumbens (NAc) shell after acute injection of cumulative doses of MXE (0.031-0.5 mg/kg IV). Finally, in vivo microdialysis was performed in freely moving rats to evaluate the effect of acute MXE administration (0.125, 0.25 and 0.5 mg/kg IV) on dopamine release in the NAc shell. RESULTS MXE 0.125 and 0.25 mg/kg, but not 0.5 mg/kg, substituted for ketamine SA. MXE also induced a dose-dependent stimulation of firing rate (p < 0.0001) and burst firing (p < 0.05) of NAc-projecting VTA dopamine neurons. Consistently, MXE significantly (p < 0.05) increased dopamine extracellular levels in the NAc shell at 0.5 and 0.25 mg/kg with different time onsets, i.e. at 40 and 100 min, respectively. CONCLUSIONS This study, while confirming the reinforcing effects of MXE, highlights an electrophysiological and neurochemical profile predictive of its addictive properties.
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Wilkins C, Parker K, Prasad J, Jawalkar S. Do police arrestees substitute legal highs for other drugs? Int J Drug Policy 2016; 31:74-9. [PMID: 26948501 DOI: 10.1016/j.drugpo.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/27/2015] [Accepted: 01/08/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs. AIMS To explore the extent to which police detainees substitute LH for illegal drugs. METHOD A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., 'no change', 'more', 'less' or 'stopped'). The detainees were placed into four groups: (i) no LH use; (ii) LH use and 'no change' in drug use; (iii) LH use and 'more' drug use; (iv) LH use and 'less' or 'stopped' drug use. Demographics and levels of drug use in the past month were compared between groups. RESULTS Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used 'less' or 'stopped' cannabis use, and 3% had used SC and used 'more' cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used 'more' cannabis also used more methamphetamine and ecstasy. CONCLUSION Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 6% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations.
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Hughes JR, Fingar JR, Budney AJ, Naud S, Helzer JE, Callas PW. Marijuana use and intoxication among daily users: an intensive longitudinal study. Addict Behav 2014; 39:1464-70. [PMID: 24935797 DOI: 10.1016/j.addbeh.2014.05.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/12/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most of the harm from marijuana use is experienced by daily users. Despite this, there has not been a detailed prospective description of daily marijuana use. METHODS We recruited daily marijuana users (n=142) by internet ads, Craigslist, flyers, etc. Participants were mostly women (58%) with a mean age of 33 and 47% were minorities. Participants called an Interactive Voice Response phone system to report marijuana and other drug use daily for 3months. RESULTS Participants averaged using marijuana 3.2 times per day. Almost all participants used multiple modes of delivery during the study. Bongs/vaporizers/pipes were the most common mode of use (45% of uses). Day-to-day variability in amount of use was relatively small. The median rating of intoxication was 3.8 on a 0-6 scale with no intoxication reported on 1% of days and severe intoxication on 24% of days. The large majority binge drank (71%) or used tobacco (73%). Fifteen during-study variables were associated with the frequency of marijuana use; running out of marijuana and social setting were the strongest correlates. Retrospective reports of "usual" use at study entry were often significantly different than daily reports of use during the study. CONCLUSIONS This is the first detailed prospective description of daily marijuana use. Most users used multiple times/day, used multiple modes to administer marijuana, were often intoxicated, and under-reported high rates of using alcohol and tobacco. The frequency of marijuana use was especially influenced by social factors. These results will help future studies better describe daily marijuana use.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States; Department of Psychology, University of Vermont, Burlington, VT 05405, United States; Department of Family Practice, University of Vermont, Burlington, VT 05405, United States.
| | - James R Fingar
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, United States
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05405, United States
| | - John E Helzer
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States
| | - Peter W Callas
- Department of Biostatistics, University of Vermont, Burlington, VT 05405, United States
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Allsop DJ, Dunlop AJ, Saddler C, Rivas GR, McGregor IS, Copeland J. Changes in cigarette and alcohol use during cannabis abstinence. Drug Alcohol Depend 2014; 138:54-60. [PMID: 24613633 DOI: 10.1016/j.drugalcdep.2014.01.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Cannabis causes lower mortality and morbidity than alcohol and tobacco so it is clinically important if quitting cannabis is associated with substitution with these substances. This study tests if cannabis is substituted with alcohol and/or tobacco during cannabis abstinence, and factors predicting such substitution. METHOD A secondary analysis of a prospective community based study quantified cannabis, alcohol and tobacco use with Timeline Follow-back during a two-week voluntary cannabis abstinence and at one-month follow-up in non-treatment seeking cannabis users (n=45). Cannabis use was verified by urine THC-COOH levels. RESULTS Alcohol use increased by 8 standard units (SU; d=0.48)/week and cigarette use by 14 cigarettes/week (d=0.29) during cannabis abstinence. Those using less of each substance at baseline had greater increases during cannabis abstinence (alcohol P<0.0001, tobacco P=0.01). There was a decrease in alcohol (-4.8 SU, d=-0.29) and tobacco (-13 cigarettes/week, d=-0.26) use at follow-up, when most participants (87%, n=39) had resumed cannabis use. Increased cigarette use was predicted by cannabis withdrawal related sleep difficulty (insomnia) (P=0.05), restlessness (P=0.03) and physical symptoms (P=0.02). Neither alcohol nor cigarette use increased significantly in those (13.3%, n=6) who remained abstinent from cannabis through to follow-up. CONCLUSIONS Abstaining from cannabis was associated with increases in alcohol and tobacco use that decreased with resumption of cannabis use; however there were no increases in individuals who remained abstinent from cannabis at one-month follow-up. Tobacco use did not increase in those experiencing milder cannabis withdrawal symptoms. Research on substitution in treatment seekers during outpatient cannabis abstinence is needed.
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Ramiro MA, Llibre JM. Legal, ethical, and economic implications of breaking down once-daily fixed-dose antiretroviral combinations into their single components for cost reduction. Enferm Infecc Microbiol Clin 2013; 32:598-602. [PMID: 24139337 DOI: 10.1016/j.eimc.2013.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022]
Abstract
The availability of generic lamivudine in the context of the current economic crisis has raised a new issue in some European countries: breaking up the once-daily fixed-dose antiretroviral combinations (FDAC) of efavirenz/tenofovir/emtricitabine, tenofovir/emtricitabine, or abacavir/lamivudine, in order to administer their components separately, thereby allowing the use of generic lamivudine instead of branded emtricitabine or lamivudine. The legal, ethical, and economic implications of this potential strategy are reviewed, particularly in those patients receiving a once-daily single-tablet regimen. An unfamiliar change in antiretroviral treatment from a successful patient-friendly FDAC into a more complex regimen including separately the components to allow the substitution of one (or some) of them for generic surrogates (in the absence of a generic bioequivalent FDAC) could be discriminatory because it does not guarantee access to equal excellence in healthcare to all citizens. Furthermore, it could violate the principle of non-maleficence by potentially causing harm both at the individual level (hindering adherence and favouring treatment failure and resistance), and at the community level (hampering control of disease transmission and transmission of HIV-1 resistance). Replacing a FDAC with the individual components of that combination should only be permitted when the substituting medication has the same qualitative and quantitative composition of active ingredients, pharmaceutical form, method of administration, dosage and presentation as the medication being replaced, and a randomized study has demonstrated its non-inferiority. Finally, a strict pharma-economic study supporting this change, comparing the effectiveness and the cost of a specific intervention with the best available alternative, should be undertaken before its potential implementation.
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Affiliation(s)
- Miguel A Ramiro
- Philosophy of Law Department, Law School, Alcala University, Alcalá de Henares, Madrid, Spain; Human Rights Institute 'Bartolomé de las Casas', Legal Clinic on HIV/AIDS, Carlos III University, Getafe, Madrid, Spain.
| | - Josep M Llibre
- Lluita contra la SIDA Foundation, Badalona, Barcelona, Spain; HIV Unit, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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