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Because of concerns about benzo-diazepine misuse and adverse events, including hip fractures among elderly, some state and national policies have tried to regulate access to these drugs. The use of benzodiazepines has been associated with cognitive dysfunction and loss of balance in the elderly.

Medicare Part D excludes benzo-diazepines from coverage, and many state government policies limit their use; however, it is not clear whether such policies have decreased the incidence of hip fracture.

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According to a British study, people older than 50 years of age who took proton pump inhibitors (PPIs) for a year or more had a significant increase in the risk of breaking a hip.

The study looked at medical records of more than 145,000 patients whose average age was 77. Patients who used PPIs for more than a year had a 44% higher risk of hip fracture than non-users.

Also known as “heartburn” or reflux agents (e.g., Nexium generic, Prevacid, Prilo-sec), PPIs may interfere with calcium absorption. Long-term PPI therapy, particularly at high doses, was associated with an increased risk of hip fracture. The researchers speculated that when the drugs reduce hydrochloric acid in the stomach, they might make it more difficult for the body to absorb bone-building calcium.

A similar but smaller risk of hip fractures for H₂ blockers (e.g., Tagamet, Pep-cid) was also noted.

Even though the study suggested only a potential association, patients should take the proper dosage, report how long they have been taking the drugs, undergo bone density testing, and follow a calcium-rich diet.

Switching transplant recipients from prednisone generic to sirolimus (Rapamune, Wyeth) and cyclosporine tablet is apparently a safe transition that may improve quality of life over the long term.

In a study from The University of Texas Medical School at Houston, 27 of 30 renal transplant patients were converted fairly seamlessly to sirolimus. Prednisone drug therapy had failed because of chronic allograft nephropathy in one recipient, disease recurrence in a second, and chronic rejection in a third. The main difference after the switch was seen in quality-of-life reports.

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The FDA has approved a Pregnancy Category B rating for insulin aspart (rDNA origin) injection (NovoLog, Novo Nordisk). This rating indicates that adequate studies of pregnant women with type-1 diabetes have shown that Novo-Log does not pose an increased risk to the unborn baby. Previously, the product had a Category C rating, which indicated that adverse effects on the fetus had occurred in animal studies and that adequate and well-controlled studies in pregnant women had not been conducted to demonstrate the product’s safety.
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In January, a new kit for the topical treatment of the inflammatory lesions of rosacea became available in pharmacies. MetroGel 1% (Galderma) has a higher concentration of generic metronidazole and a reduced dosage of once-daily versus twice-daily use, compared with the previously available MetroGel 0.75%. The new vehicle incorporates HSA-3, a combination of niacinamide, betadex, and propylene glycol. The vehicle is water-based and contains no alcohol.

MetroGel 1% is available by prescription only. The kit contains a 60-g tube of MetroGel, a complimentary 4-ounce bottle of a nonprescription skin cleanser, and a patient brochure.

The FDA has approved the first generic versions of Zofran drug (ondansetron) tablets, orally disintegrating tablets, and oral solution. These products are indicated to prevent nausea and vomiting associated with surgery, radiotherapy, and cancer chemotherapy.

Ondansetron tablets (Dr. Reddy Laboratories) and the disintegrating tablets (Kali Laboratories) are available in strengths of 4 mg, 8 mg, 16 mg, and 24 mg. Roxane Labs manufactures the oral solution, 4 mg (base)/5 ml.

Although spinal anesthesia has been performed since the late 1800s, postdural puncture headache (PDPH) continues to be a problem for patients and a challenge for clinical staff members.

The cardinal feature of this type of headache is associated with posture; the pain worsens when patients are sitting or standing and improves when patients are supine. Pain occurs in the frontal, temporal, or occipital regions on both sides and can be accompanied by neck stiffness, backache, and nausea. In approximately 15% of cases, PDPH is so severe that patients cannot eat, drink, or carry out activities of daily living.

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