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Among young patients with cancer, a psychoeducational intervention reduces the percentage of patients requiring anesthesia during radiation treatment, Swiss researchers report in a June 4th issue of the BioMed Central journal Radiation Oncology.
Reuters Health Information

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The synergistic drug candidate CRx-102, which combines dipyridamole with low dose prednisolone, is a safe and effective treatment for reducing pain in patients with hand osteoarthritis, according to a report in the June 19th issue of the Annals of the Rheumatic Diseases.
Reuters Health Information

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Maribavir, a novel inhibitor of a viral protein kinase of human cytomegalovirus (CMV), reduces the incidence of CMV infection in allogeneic stem cell transplant recipients, according to a report in the June 1st issue of Blood.
Reuters Health Information

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The July issue of the Drug Safety Update from the MHRA provides a reminder of the reports of suicidal thoughts and behaviour, not only in those with pre-existing psychiatric conditions or other psychosocial risk factors, but also in users of varenicline who have no known pre-existing psychiatric conditions, and in those who continue to smoke. The following advice for healthcare professionals is reiterated:

• Patients should be told to stop treatment and contact their doctor immediately if they develop suicidal thoughts or behaviour.
• Varenicline should be stopped immediately if agitation, depressed mood, or changes in behaviour are observed that are of concern to the patient, family, or caregivers.
• The safety and efficacy of varenicline in people with serious psychiatric illness have not been established; those with such a history should be monitored closely while taking varenicline.

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The July issue of the Drug Safety Update from the MHRA provides a reminder of the reports of an increased risk of atrial fibrillation (AF) with use of zoledronic acid (Aclasta®), pamidronic acid, and possibly with alendronic acid. The overall conclusion was that “The risk of AF in association with bisphosphonate treatment seems to be low, and the balance of risks and benefits for bisphosphonates remains favourable.” The product information for zoledronic acid has been updated to include AF as a possible side-effect (both for Aclasta® and Zometa®), and this side effect is also being added to the product information for pamidronic acid.

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The latest “hot topic” article in the July issue of the Drug Safety Update from the MHRA focuses on corticosteroid (beclometasone; budesonide; ciclesonide; fluticasone; and mometasone) containing inhaled products, and summarises licensed doses, differences in potency between products, and their use with spacer devices. The following advice for healthcare professionals is reiterated:

• Prescribe CFC-free beclometasone metered-dose inhalers by brand name to reduce the risk of dosing errors.
• Pharmacists are reminded that for any generic prescription for beclometasone, they should establish whether a CFC-free product is required and if so, which brand should be dispensed.
• Clenil Modulite® may be used in children (with the Volumatic spacer device) and adults.
• Qvar® is not recommended for use in children.

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The July issue of the Drug Safety Update from the MHRA provides a reminder of the new prescribing and storage instructions for rotigotine patches (Neupro®). This follows reports of crystal formation that is visible as a snowflake pattern in the patch, and the observation that refrigeration seems to reduce crystal development. Consequently, the manufacturers will be supplying refrigerated batches to replace products that remain in the distribution chain; from the end of July 2008, only 2 mg and 4 mg 24-hour patches will be available for an interim period. The following advice for healthcare professionals is reiterated:

• Be attentive to any signs that suggest lack of efficacy, and report any cases on the Yellow Card.
• To prioritise supply for patients currently on rotigotine, limit every prescription to 1 month’s supply and do not initiate any new patients on this treatment.
• Inform patients that the patches are currently available and can be used: they must not stop using their current patches, even if they notice snowflake patterns on the patch, without first speaking to a healthcare professional.
• Patients must not abruptly stop treatment as this has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crisis.
• Patients should be advised to store their rotigotine patches in the refrigerator; patches must not be stored in the freezer; they should apply and maintain gentle pressure with the palm on the hand for at least 1 minute for adhesion.

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The July issue of the Drug Safety Update from the MHRA provides a reminder of the new warnings and contraindications for the ergot-derived dopamine agonists, following recent warnings from the European Medicines Agency about the risk of fibrosis associated with chronic use. The following advice for healthcare professionals is reiterated:

• Prescribe ergots according to the updated prescribing information (see links for further prescribing information).
• Ergots should not be given to patients who have had fibrosis in the heart, lungs, or abdomen; absence of cardiac fibrosis should be verified before treatment is started.
• Monitor patients for signs of fibrosis during treatment by use of blood tests, echocardiography, or chest radiography as appropriate.

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The July issue of the Drug Safety Update from the MHRA provides a reminder of the new prescribing recommendations for 90mg etoricoxib (Arcoxia®) for the treatment of rheumatoid arthritis and ankylosing spondylitis, following a review of the benefits and risks by the European Medicines Agency (see NeLM link). The following advice for healthcare professionals is reiterated:

• Prescribe etoricoxib in accordance with the updated product information (see links for information).
• Monitor patients closely for any signs and symptoms of cardiovascular side-effects (e.g. fluid retention, high BP, shortness of breath, or chest pain).

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