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The latest Mainline newsletters for the General Public are listed here.


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For healthcare professionals we have a Mainline newsletter in a Professional version here.


     Alert

What will 1 out of every three seniors experience this year? A Fall! Why?

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Mainline-Pro

Volume 2 August 23, 2005 Number 4

An Exclusive Continuing Education Publication of Acadiana Consultant Pharmacy Service
Author, Publisher, Editor-in Chief, Typesetter & Printer, Charles S. Feucht,PD,FASCP PharmD candidate

________________________________________________________________________________________________________________________

Medication News & Update

DERMATOLOGY

     Drug absorption from a patch can be dangerously increased by heat. This can be from sunbathing, heating pads, exercise, and even a fever.
     A fever of 104°F can potentially increase Duragesic (fentanyl) levels by one-third. Heat can also shorten the duration of action...from three days to two.
     Warm skin allows more drug to be absorbed by increasing blood flow and skin permeability.
     Heating the patch can also increase drug release...leading to a shorter duration of action.
     Patients who exercise a lot...spend time in the sun...or expose their patch to heat, need to watch for signs of overdose. They should also realize that the patch doesn't last as long.

Insomnia

     A new non-narcotic sleep aid has been approved. Ramelteon (Rozerem) is indicated for sleep onset insomnia. It does not help to maintain sleep. It is an effectgive alternative to the narcotic sleep aid Sonata which is also only indicated for sleep onset insomnia. Unlike other prescription sleep medications, ramelteon works by selectively affecting melatonin MT1 and MT2 receptors, which are believed to be involved in the circadian rhythm underlying the normal sleep-wake cycle. Most other sleep aids prescribed work by binding to gamma-aminobutyric acid (GABA) receptors, which reduce central nervous system activity. Because of its mechanism of action Ramelteon has been shown to carry no risks of abuse, withdrawal, or dependency, and negligible risk for next-day hangover effects.

      Ramelteon is hepatically metabolized, primarily by the CYP1A2 isoenzyme. The manufacturer advises that ramelteon not be used in combination with fluvoxamine, a strong CYP1A2 inhibitor. The coadministration of the two agents has been shown to significantly increase ramelteon concentrations. Additionally, ramelteon should be administered with caution in patients taking rifampin, ketoconazole, and fluconazole.

The most common adverse events associated with ramelteon in clinical trials were somnolence, dizziness, nausea, and fatigue. Ramelteon has been associated with decreased testosterone levels and increased prolactin levels. Therefore, the package labeling recommends that for patients presenting with any unexplained symptoms possibly associated with these hormone level changes, assessment of prolactin and testosterone levels should be considered appropriate.   for more information contact us.

_______________________

Charles S. Feucht, PD,FASCP

For questions or more information contact

                            Acadiana Consultant Pharmacy Service        

P.O. Box 1288, Eunice, LA, 70535,  Office (337) 457-4604, Fax (337) 546-0900

Cell (337) 344-2297,  Emails: rxinfo@rxpertusa.com

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