Oral pilocarpine: new preparation. Xerostomia after radiation therapy: moderately effective but costly.

(1) Dry mouth (xerostomia) is a frequent complication of radiation therapy for cancers of the ear nose and throat. Local measures such as saliva substitutes and anetholtrithione are either moderately effective, inadequately evaluated or little better than placebo. (2) Marketing authorization has been granted in France for an oral formulation of pilocarpine, an old parasympathomimetic agent, in the treatment of radiotherapy-induced xerostomia. (3) According to the results of two double-blind trials, pilocarpine (15-30 mg/day) improves symptoms in about 50 % of patients, compared to improvement in 25% of patients taking placebo. The drug is slow to take effect and has little impact on daily life. It is not known whether pilocarpine helps prevent the complications of xerostomia. (4) Most adverse effects of pilocarpine are due to its parasympathomimetic effects, such as sweating, urinary frequency, flushing, rhinitis and nausea. Pilocarpine must therefore be used with caution in patients with asthma, cardiac arrhythmia, iridocyclitis, and closed-angle glaucoma. (5) In France, this pilocarpine formulation costs 18 times more than a preparation of pilocarpine 2% eye drops used orally (off licence). (6) In practice, patients needing symptomatic treatment of xerostomia after radiotherapy may benefit from oral pilocarpine but, given its limited efficacy and its adverse effects, other local treatments should be tried first.

[Analysis of glaucoma therapy costs in Poland. I--population of the Mazovian District]. / Analiza kosztów leczenia jaskry w Polsce. Czesc I--Populacja mazowiecka.

AIM OF THE STUDY: The purpose of this study was to estimate and evaluate costs of glaucoma therapy in Poland in 1998-2000 years. MATERIAL AND METHODS: 315 patients (591 eyes) including 364 POAG eyes and 227 PACG eyes were evaluated. Progression of the disease was measured in two modes: by changes in the optical nerve disc (c/d) and by IOP level. Duration of the study was 12 months. Total costs (e.g. number of visits, amount of medications used, surgical and laser procedures performed) were calculated on 100 eyes/12 months. RESULTS: Pharmacological therapy constitutes 40-50% of the total costs in both glaucoma types. Timolol was the mostly prescribed drug in POAG, while pilocarpine led in PACG group. Dorzolamide was on the third place, but it generated the biggest part of total costs. Patients with advanced forms of the disease more frequently saw doctor on visits (average 6 visits per year); patients with elevated IOP (> 21 mm Hg) underwent surgical procedures more commonly than these with optical nerve disc changes (c/d > 0.6). The total costs of the therapy of non-advanced cases amounted 70.243 PLN on the average, while in advanced cases it reached the average of 155.230 PLN. CONCLUSION: 1. The total cost of glaucoma therapy depends on progression of the disease. 2. The most cost-generating part is the pharmacological therapy of glaucoma.

First effective drug for dry mouth.

AIDS: The Food and Drug Administration (FDA) approved oral pilocarpine (Salagen) for the treatment of dry mouth in patients receiving radiation therapy for head and neck cancer. There are possible drug interactions with the beta blockers that are often used by cardiac patients. Other side effects are sweating, nausea, and inflammation of the mucous membranes.^ieng

[Single dose administration in therapy of glaucoma. Comparison of costs with multiple dose]. / Einzeldosisapplikationen in der Glaukomtherapie. Vergleich der Kosten mit Mehrdosis.

Preservatives in antiglaucomatous agents can irritate the conjunctiva and may lead to allergic reactions. Preservative-free single-dose applications of glaucoma medications have increasingly become available. We analysed the therapy costs for single-dose containers per eye and per year and compared them with those for multidose containers. The data were calculated from prices taken from the German pharmacy index, applications per day and number of drops in the container. The drop volume ranged from 34.3 microliters to 48.0 microliters for single-dose containers and from 29.2 microliters to 40.0 microliters for multidose containers. The annual cost of therapy with beta-adrenergic antagonist preparations was DM 42.59-DM 80.78 for multidose containers and DM 162.73-DM 242.42 for single-dose containers. The cost of therapy with philocarpine was DM 21.55 but DM 233.92 for single-dose containers. The cost of combination therapy with beta-adrenergic antagonist preparations and pilocarpine ranged from DM 67.92 to DM 214.33 for multidose containers and from DM 408.15 to DM 428.95 using single-dose containers. Therapy with preparations in single-dose containers is more expensive than with multidose containers (+161 to +1169%). Preparations in single-dose containers without preservatives can have advantages, but the higher costs necessitate careful selection of the patients.

Medical and socio-economic aspects of long term therapy of open angle glaucoma.

Hundred patients of open angle glaucoma (OAG) who were on any one of the three drugs pilocarpine, timolol and epinephrine--for an average period of 3.3 years were chosen. Proforma regarding socio-economic status and the patients' reaction to long-term medication were recorded. Though the objective and subjective effects of long term medication were negligible the financial constraints were considerable. More than 70% patient would prefer laser's and surgery because of the cumbersome schedule and financial burden. The visit to the clinic was a time consuming process suggesting a lack of adequate glaucoma follow-up at the peripheral level. The study reflects a need for reorientation of glaucoma management.