Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/supply & distribution , Cyclooxygenase 2 Inhibitors/supply & distribution , Gastrointestinal Hemorrhage/prevention & control , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/economics , Cost-Benefit Analysis , Cyclooxygenase 2 Inhibitors/adverse effects , Cyclooxygenase 2 Inhibitors/economics , Databases, Factual/statistics & numerical data , Gastrointestinal Hemorrhage/chemically induced , Gastrointestinal Hemorrhage/epidemiology , Humans , Risk Assessment , United States/epidemiology , United States Department of Veterans AffairsSubject(s)
Dopamine Agonists/adverse effects , Narcolepsy/chemically induced , Parkinson Disease/drug therapy , Restless Legs Syndrome/drug therapy , Aged , Benzothiazoles , Dopamine Agonists/therapeutic use , Female , Humans , Indoles/adverse effects , Indoles/therapeutic use , Male , Middle Aged , Pergolide/adverse effects , Pergolide/therapeutic use , Pramipexole , Thiazoles/adverse effects , Thiazoles/therapeutic useSubject(s)
Isoenzymes/antagonists & inhibitors , Isoxazoles/therapeutic use , Lactones/therapeutic use , Sulfonamides/therapeutic use , Aged , Aged, 80 and over , Arthritis, Rheumatoid/drug therapy , Celecoxib , Chronic Disease , Cost Savings , Cyclooxygenase 2 , Drug Utilization Review , Endpoint Determination , Female , Hospitals, Veterans , Humans , Isoxazoles/economics , Isoxazoles/pharmacokinetics , Lactones/economics , Lactones/pharmacokinetics , Male , Membrane Proteins , Osteoarthritis/drug therapy , Pain/drug therapy , Prostaglandin-Endoperoxide Synthases , Pyrazoles , Sulfonamides/economics , Sulfonamides/pharmacokinetics , Sulfones , Therapeutic EquivalencySubject(s)
Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Mass Screening/economics , Peptic Ulcer/prevention & control , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/economics , Anti-Ulcer Agents/therapeutic use , Cost-Benefit Analysis , Helicobacter Infections/complications , Humans , Peptic Ulcer/microbiology , Premedication , Treatment Outcome , United States , VeteransABSTRACT
The interaction of celecoxib and rofecoxib with warfarin was studied. Patients stable on warfarin therapy and concurrently taking a cyclooxygenase-2 (COX-2) inhibitor comparator (traditional nonsteroidal antiinflammatory medications, salsalate, or acetaminophen) randomly received celecoxib 200 mg/day or rofecoxib 25 mg/day for three weeks. After a one-week washout period, the patients were crossed over to treatment with the opposite COX-2 inhibitor for three more weeks. The International Normalized Ratio (INR) was measured at baseline and at weeks 1, 2, and 3 of therapy with each COX-2 inhibitor by testing blood samples obtained by finger stick. Data for 16 patients were analyzed. The INR increased by 13%, 6%, and 5% on average in patients taking celecoxib at weeks 1, 2, and 3, respectively, and by 5%, 9%, and 5% in patients taking rofecoxib. Changes in the INR were statistically significant at week 1 for celecoxib and at week 2 for rofecoxib. Of the 12 subjects who had a clinically significant > or = 15% change in the INR while receiving either COX-2 inhibitor, 4 showed this change for both agents. Adverse drug reactions were similar for each COX-2 inhibitor, but the rate of edema requiring medical intervention was higher in the rofecoxib group. Significant increases in the INR were observed in patients who were stable on warfarin therapy after the addition of therapy with rofecoxib or celecoxib.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anticoagulants/adverse effects , Cyclooxygenase Inhibitors/adverse effects , Lactones/adverse effects , Sulfonamides/adverse effects , Warfarin/adverse effects , Aged , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Celecoxib , Cross-Over Studies , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Cyclooxygenase Inhibitors/pharmacology , Drug Synergism , Female , Humans , International Normalized Ratio , Isoenzymes/antagonists & inhibitors , Lactones/pharmacology , Male , Membrane Proteins , Prospective Studies , Prostaglandin-Endoperoxide Synthases , Pyrazoles , Sulfonamides/pharmacology , SulfonesSubject(s)
Benzimidazoles/pharmacology , Digoxin/blood , Proton Pump Inhibitors , 2-Pyridinylmethylsulfinylbenzimidazoles , Aged , Benzimidazoles/therapeutic use , Digoxin/therapeutic use , Drug Interactions , Formularies, Hospital as Topic , Humans , Lansoprazole , Male , Omeprazole/analogs & derivatives , Omeprazole/therapeutic use , Prospective Studies , RabeprazoleABSTRACT
BACKGROUND AND AIMS: Autonomic dysreflexia is a common and potentially dangerous response in patients with spinal cord injury at T6 or above. Acute blood pressure elevation may be precipitated by rectosigmoid distention and anal manipulation. Topical anesthetics are widely recommended to minimize the incidence and severity of autonomic dysreflexia, although no scientific evidence supports or refutes this practice. This study tested whether topical lidocaine would prevent or limit anorectal procedure-associated autonomic dysreflexia. PATIENTS AND METHODS: We enrolled patients with chronic, complete spinal cord injury scheduled for anoscopy and/or flexible sigmoidoscopy. In a double-blind fashion they were randomized to receive either 2% lidocaine jelly (n = 18) or nonmedicated lubricant (control; n = 32) just prior to the procedure. We measured blood pressure before, during, and after procedures. RESULTS: Mean maximal systolic blood pressure increased 35 +/- 25 mmHg in the lidocaine group vs. 45 +/- 30 mmHg in the control group (NS). However, there was a significant difference between anoscopic procedures and flexible sigmoidoscopies without anoscopy (49 +/- 29 vs. 25 +/- 20 mmHg). CONCLUSION: Topical lidocaine did not significantly limit or prevent autonomic dysreflexia in susceptible patients. Both anoscopy and flexible sigmoidoscopy caused significant blood pressure elevation. Anoscopy, which involves stretching of the anal sphincters, was a more potent stimulus for autonomic dysreflexia than flexible sigmoidoscopy, which involves gaseous distention of the rectosigmoid. Anal sphincter stretch and rectosigmoid distention, rather than a mucosal stimulus, are likely nociceptive triggers for procedure-associated autonomic dysreflexia.