Excretion of ibuprofen into breast milk.

Concentrations of ibuprofen in breast milk and serum were compared in 12 patients who had ingested one 400 mg tablet of ibuprofen every 6 hours over a 24-hour period for relief of post-cesarean section pain. Samples of breast milk and blood were obtained simultaneously over a 34-hour period beginning just prior to the first dose of ibuprofen. Gas-liquid chromatography assay methodology capable of detecting 1 microgram/ml was used to determine concentrations of ibuprofen in serum and breast milk. Ibuprofen was present in the serum with a half-life of approximately 1.5 hours. No measurable amounts of ibuprofen were found in the samples of breast milk. The conclusion drawn is that, in lactating women who take up to 400 mg of ibuprofen every 6 hours, less than 1 mg of ibuprofen per day is excreted in breast milk.

The family physician's knowledge of the cost of prescribed drugs.

In this study practicing physicians, residents and teaching faculty estimated cost to the patient of ten commonly prescribed drugs. Physician estimates were compared to averaage pharmacy prices. On the whole, physicians overestimated the costs of the drugs. Practicing physicians had the highest estimated while residents were the most accurate. Accuracy of price estimates differed greatly among the drugs. Physicians were also asked about their sources of drug price information and their prescribing policies in relation to cost. Residents and faculty relied heavily on pharmacists for the drug price information, whereas practicing physicians rellied on sales representatives and patients. Virtually all responders assign at least some importance to drug costs when prescribing. Residents and faculty reported prescribing generically more often than practicing physicians.

Metronidazole in breast milk.

Breast milk concentrations of metronidazole were assayed in 3 women who had been treated with a single 2.0-g dose for trichomoniasis. Highest concentrations of the drug were found 2 and 4 hours after administration, and they declined over the next 12 to 24 hours. It appears that if breast-feeding is withheld for 12 to 24 hours after the dose, infants will be exposed to a greatly reduced amount of metronidazole. As the use of metronidazole in nursing mothers is currently not recommended, this may be the regimen of choice for the treatment of trichomoniasis in lactating women.

Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis).

Use of oral contraceptives was associated with a significant increase in the frequency of dry socket after extraction of mandibular third molars. The probability of dry socket increases with the estrogen dose in the oral contraceptive. The risk of dry socket associated with oral contraceptives can be minimized by performing extractions during days 23 through 28 of the tablet cycle.

PIP: A patient population consisting of women currently taking oral contraceptives (OCs) and who were scheduled to undergo extraction of third molars was examined to establish any connection between postoperative sequelae, specifically higher incidence of dry socket (localized alveolar osteitis) in dental patients using OCs. 71 third molar extractions were performed on 47 OC users. Mandibular third molars extracted during Days 1-22 of the OC cycle (Day 22 was considered the last day of estrogen influence) had significantly higher frequency of dry socket than those removed during Days 23-28. Of the 58 extractions during Days 1-22, 18 (31%) resulted in dry sockets compared with none of the 13 extractions during Days 23-28 (P=.0145). The effect of estrogen dose on frequency of dry socket was also computed. The risk of dry socket increased with increased estrogen dose in the OCs (P .01). Therefore, the risk of dry socket can be minimized by performing extractions during Days 23-28 of the OC tablet cycle.

The use of drugs for unlabeled indications.

A chart review of 500 drug uses during a three-month period in a family practice clinic showed that 46 (9.2%) were for indications not included in the Food and Drug Administration-approved labeling. Dipyridamole was the drug most frequently and consistently prescribed for unlabeled indications. On no occasion did the chart show that patients were informed that a drug was being prescribed for an unlabeled indication. Unlabeled indications most frequently encountered in the chart review were also frequently mistaken by family practice residents and faculty responding to a questionnaire as being included in FDA-approved labeling. The indications as listed in the manufacturers' literature (eg, package insert, Physician's Desk Reference) often do not reflect how drugs are used in clinical practice.

Primary care by a pharmacist in an outpatient clinic.

Primary care by a pharmacist in an outpatient clinic of the Indian Health Service is described. Primary care responsibilities of the pharmacist included the diagnosis and treatment of certain acute illnesses and the management of selected chronic disease patients. Protocols were written by the pharmacist and physician to cover 31 acute illnesses and seven chronic conditions. The pharmacist was also trained to perform many routine laboratory tests. Further, the pharmacist provided patient consultation as to the use, storage, benefits and expected side effects of prescribed medications. Pharmacy visits accounted for nearly one-third of the clinic visits in 1975. Diagnosis and treatment of 10 common acute illnesses made up more than 40% of the pharmacy visits; another 40% of these visits were for pharmacist monitoring of chronic conditions.