Fingolimod in multiple sclerosis: profile of use in habitual practice.

OBJECTIVES: Fingolimod is the first oral drug indicated in monotherapy as a modifier of the course of very active relapsing-remitting multiple sclerosis (RRMS). The safety profile of fingolimod is well established in clinical trials and post-marketing studies. Our objective was to study the profile of fingolimod use in our health area. METHODS: A retrospective, observational, descriptive study was performed on the use of fingolimod in adult patients diagnosed with RRMS between January 2015 and February 2017 or until suspension of treatment in a reference hospital in north-western Spain. RESULTS: A total of 55 patients were included with a mean±SD time of treatment with fingolimod of 26±14.6 months (range 2-53). Thirteen patients permanently discontinued the treatment (10 due to outbreaks/disease progression and 3 due to adverse effects). No statistically significant differences were found between the percentage of patients who discontinued fingolimod and who had received only one previous treatment and those who had received two or more treatments. No cases of symptomatic bradycardia were reported. CONCLUSIONS: Fingolimod is a safe treatment for patients with multiple sclerosis.

Refractory orthostatic hypotension in a patient with a spinal cord injury: Treatment with droxidopa.

CONTEXT: Orthostatic hypotension (OH) is a common complication in patients with a spinal cord injury, mainly affecting complete injuries above neurological level T6. It is generally more severe during the acute phase but can remain symptomatic for several years. FINDINGS: A 65-year-old male with a grade ASIA A post-traumatic cervical spinal cord injury, at neurological level C4, presenting with symptomatic refractory OH. Increased blood pressure (BP) levels and an overall clinical improvement was observed after administering an increasing dose of droxidopa. Treatment was started at a dose of 100 mg twice daily (bid), one to be taken upon rising in the morning and another one in the afternoon, at least three hours before bedtime. According to the patient's symptomatic response, each individual dose was increased by 100 mg at 48-hour intervals. Both increased mean BP levels and a subjective symptomatic improvement were evidenced at a dose of 300 mg bid. CLINICAL RELEVANCE: Treatment with droxidopa increases BP levels and improves symptoms related to refractory OH using all physical and pharmacological measures available. It could therefore constitute an effective alternative treatment for OH in patients with a spinal cord injury.

Study of cases of abiraterone discontinuation due to toxicity in pre-chemotherapy after 1 year's experience.

Abiraterone acetate is a potent and irreversible inhibitor of cytochrome p450 17A1 that suppresses androgen synthesis. It is approved for chemotherapy-naive and docetaxel-treated patients with metastatic castration-resistant prostate cancer. We describe the protocol for use of abiraterone in metastatic castration-resistant prostate cancer chemotherapy naive patients has been implanted in our centre and we review the cases of those patients whose adverse effects have forced the discontinuation of treatment. The side effects fit the safety profile of abiraterone, speed of their appearance and severity indicate that you should perform a thorough follow-up of these patients especially in the early phases of treatment.

[Evaluation of the pilot program of medicine dispensation in customized doses in Galicia [Spain]]. / Evaluación del Programa Piloto de Dispensación de Medicamentos en Dosis Personalizada en Galicia.

OBJECTIVE: To quantify, from an economic perspective, the results of the Pilot Program of Dispensation of Medicines in Unitary Dose in Galicia, Spain. PATIENTS AND METHODS: Retrospective study from 35,923 antibiotic prescriptions in customized doses corresponding to 5 active principles (amoxicillin, amoxicilin/clavulanic, claritromicin, cefuroxima axetil and ciprofloxacin). The program, which worked during 12 months, included 292 physicians from 46 units of primary care of the Galician Health Service and 167 offices of pharmacy. RESULTS: 60.57% of the prescribed treatments did not adjust exactly to the conventional presentations existing in the market. Savings in units of antibiotic of the dispensation in customized doses compared with the conventional one has been of 14.32%. Registered economic saving has been of 29.94%. The inclusion of 2 new presentations in amoxiciline and amoxiciline/clavulanic (of 15 and 21 tablets) and of one in the other 3 (cefuroxime and ciprofloxacin of 14 tablets and clarithromycin of 16) would avoid 86.5% of the leftover units without having to implement individualized dispensation. CONCLUSIONS: An important antibiotic stock is being generated in home medicine cabinets as a result of the leftovers of prescribed treatments that in the case of Galicia are equivalent to more than 1,800,000 doses of antibiotic in 2004. This problem could be reduced with the dispensation in customized dose and partially with new presentations.

Evaluación del Programa Piloto de Dispensación de Medicamentos en Dosis Personalizada en Galicia / Evaluation of the Pilot Program of Medicine Dispensation in Customized Doses in Galicia

Objetivo: Evaluar, desde una perspectiva económica, los resultados del Programa Piloto de Dispensación de Medicamentos en Dosis Personalizada en Galicia. Pacientes y métodos: Estudio retrospectivo de las 35.923 recetas de antibióticos (amoxicilina, amoxicilina/clavulánico, claritromicina, cefuroxima axetilo y ciprofloxacino) en dosis personalizada generadas en el programa de 12 meses de duración en el que participaron 292 médicos de familia de 46 unidades de atención primaria del Servicio Gallego de Salud y 167 oficinas de farmacia. Resultados: El 60,57% de los tratamientos prescritos no se ajustaba de manera exacta a las presentaciones disponibles en el mercado. El ahorro, en número de unidades, de la dispensación en dosis personalizada frente a la convencional fue del 14,32%. El ahorro económico fue del 29,94%, lo que supondría un 0,46% de la facturación en Galicia. La inclusión de 2 presentaciones nuevas en amoxicilina y amoxicilina/clavulánico (de 15 y 21 comprimidos) y de una en los otros 3 (cefuroxima y ciprofloxacino de 14 comprimidos y claritromicina de 16) evitaría el 86,5% de las unidades sobrantes. Conclusiones: El importante sobrante de tratamientos prescritos (1.800.000 dosis de antibiótico en 2004 para el caso de Galicia) podría reducirse con la dispensación en dosis personalizada y, parcialmente, con la entrada en el mercado de nuevas presentaciones

Objective: To quantify, from an economic perspective, the results of the Pilot Program of Dispensation of Medicines in Unitary Dose in Galicia, Spain. Patients and methods: Retrospective study from 35,923 antibiotic prescriptions in customized doses corresponding to 5 active principles (amoxicillin, amoxicilin/clavulanic, claritromicin, cefuroxima axetil and ciprofloxacin). The program, which worked during 12 months, included 292 physicians from 46 units of primary care of the Galician Health Service and 167 offices of pharmacy. Results: 60.57% of the prescribed treatments did not adjust exactly to the conventional presentations existing in the market. Savings in units of antibiotic of the dispensation in customized doses forehead to the conventional one has been of 14.32%. Registered economic saving has been of 29.94%. The inclusion of 2 new presentations in amoxiciline and amoxiciline/ clavulanic (of 15 and 21 tablets) and of one in the other 3 (cefuroxima and ciprofloxacine of 14 tablets and claritromicine of 16) would avoid 86.5% of the leftover units without having to implement individualized dispensation. Conclusions: An important antibiotic stock is being generated in the domestic medicine kits as a result of the leftovers of prescribed treatments that in the case of Galicia are equivalent to more than 1,800,000 doses of antibiotic in 2004. This problem could be reduced with the dispensation in customized dose and partially with new presentations