Medication Monitor



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  • January 12, 2015

    FDA has approved the anticlotting drug edoxaban to reduce the risk of stroke and dangerous blood clots in patients with atrial fibrillation that is not caused by a heart valve problem.

    Edoxaban also has been approved to treat deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients who have already been treated with an anticlotting drug administered by injection or infusion for 5 to 10 days.

    Safety and efficacy of edoxaban in treating patients with atrial fibrillation not caused by cardiac valve disease was studied in a clinical trial of 21,105 participants.The trial compared two dose levels of edoxaban with the anticlotting drug warfarin for their effects on rates of stroke and dangerous blood clots.

    Trial results showed the higher dose of edoxaban to be similar to warfarin for the reduction in the risk of stroke. While warfarin is highly effective in reducing the risk of stroke in patients with atrial fibrillation, it increases the risk of bleeding. Edoxaban demonstrated significantly less major bleeding compared with warfarin.

    Edoxaban for treatment of patients with DVT and PE was studied in 8,292 participants. The study compared the safety and efficacy of edoxaban to warfarin for treating patients with a DVT and/or PE to reduce the rate of recurrence of symptomatic venous thromboembolism (VTE) events (which includes DVT, PE, and VTE-related death). In the trial, 3.2% of participants taking edoxaban had a symptomatic recurrent VTE, compared with 3.5% of those taking warfarin.

    The most common adverse effects observed in trial participants were bleeding and anemia. As with other FDA-approved anticlotting drugs, bleeding, including life-threatening bleeding, is the most serious risk with edoxaban. No treatment has been proven to reverse edoxaban's anticoagulant effect.

    Edoxaban has a boxed warning that provides important dosing and safety information for health professionals about specific patient groups, including a warning that edoxaban is less effective in atrial fibrillation patients with a creatinine clearance greater than 95 mL per minute. This should be assessed before initiating therapy with edoxaban. Patients with creatinine clearance greater than 95 mL per minute have an increased risk of stroke compared with similar patients given warfarin. Edoxaban should not be used in nonvalvular atrial fibrillation patients with a higher creatinine clearance. Another anticoagulant should be used instead.

    As with other anticoagulants, the boxed warning counsels that premature discontinuation of edoxaban increases the risk of stroke and notes that spinal or epidural hematomas may occur in patients treated with edoxaban who are receiving anesthesia injected around the spine or undergoing spinal puncture.

  • February 3, 2015

    FDA has approved first-in-class empagliflozin/linagliptin tablets as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes when both empagliflozin and linagliptin are appropriate treatments.

    It is the first and only diabetes treatment in the United States to combine the dual mechanisms of action of a sodium–glucose cotransporter-2 (SGLT-2) inhibitor and a dipeptidyl peptidase-4 (DPP-4) inhibitor in a once-daily tablet taken in the morning.

    Approval was based on a Phase III clinical trial that evaluated the efficacy and safety of empagliflozin/linagliptin (10/5 mg and 25/5 mg) compared with the individual components of empagliflozin (10 mg or 25 mg) or linagliptin (5 mg) in adults with type 2 diabetes who were also taking high-dose metformin (mean dose 1,889 mg daily). The study randomized 686 adults with type 2 diabetes and hemoglobin glycosylated hemogoblin (A1C) between 7.0% and 10.5% to examine the change from baseline in A1C at 24 weeks.

    As an add-on to metformin, empagliflozin/linagliptin showed statistically significant reductions in A1C compared with empagliflozin and linagliptin alone at 24 weeks. Although not approved for lowering weight, the combination drug provided significant weight loss at 24 weeks compared with linagliptin alone.

    Empagliflozin/linagliptin is not recommended in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

    The most common adverse effects include urinary tract infections, stuffy or runny nose and sore throat, and upper respiratory tract infections.

  • May 8, 2013

    TriMix Laboratories announced the release of combination prostaglandin E, papaverine, and phentolamine for the treatment of erectile dysfunction (ED) in patients who cannot tolerate self-injection with a needle or for whom phosphodiesterase type 5 inhibitors such as sildenafil, vardenafil, or tadalafil do not work.

    Each dose contains TriMix in powder form, which becomes a gel when applied. In liquid form, TriMix is a smooth muscle relaxant that increases intracellular cyclic adenosine monophosphate levels. This leads to expansion of the lacunar spaces and entrapment of blood by compressing the venules against the tunica albuginia.

    TriMix-gel, available in a 2,000-µg dose, should be compounded by a licensed pharmacy and shipped directly to the patient.

  • September 29, 2015

    FDA has approved insulin degludec injection under the trade name Tresiba and insulin degludec/insulin aspart injection under the trade name Ryzodeg 70/30 to improve blood glucose control in adults with diabetes.

    Tresiba is a long-acting insulin analog indicated to improve glycemic control in adults with type 1 and 2 diabetes. Dosing should be individualized according to the patient’s needs. Tresiba is administered subcutaneously once daily at any time of day.

    Efficacy and safety of Tresiba used in combination with mealtime insulin for the treatment of patients with type 1 diabetes were evaluated in two 26-week and one 52-week active-controlled clinical trials involving 1,102 participants exposed to Tresiba.

    Efficacy and safety of Tresiba used in combination with mealtime insulin or used as add-on to common background oral antidiabetic drugs for the treatment of patients with type 2 diabetes were evaluated in four 26-week and two 52-week active-controlled clinical trials involving 2,702 participants exposed to Tresiba.

    In participants with type 1 and 2 diabetes who had inadequate blood sugar control at trial entry, treatment with Tresiba provided reductions in glycosylated hemoglobin (A1C) in line with reductions achieved with other, previously approved long-acting insulin.

    Ryzodeg 70/30 is a mixture of insulin degludec, a long-acting insulin analog, and insulin aspart, a rapid-acting human insulin analog.

    Efficacy and safety of Ryzodeg 70/30 used in combination with mealtime insulin for the treatment of patients with type 1 diabetes were evaluated in one 26-week active controlled clinical trial involving 362 participants exposed to Ryzodeg 70/30.

    Efficacy and safety of Ryzodeg 70/30 administered once or twice daily for the treatment of patients with type 2 diabetes were evaluated in four active-controlled 26-week clinical trials involving 998 participants exposed to Ryzodeg 70/30.

    In participants with type 1 and 2 diabetes who had inadequate blood glucose control at trial entry, treatment with Ryzodeg 70/30 provided reductions in A1C equivalent to reductions achieved with other, previously approved long-acting or pre-mixed insulin.

    Tresiba and Ryzodeg should not be used in those who have diabetic ketoacidosis. Patients or caregivers should monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision. Tresiba and Ryzodeg may cause hypoglycemia, which can be life-threatening. Patients should be monitored more closely with changes to insulin dosage, coadministration of other glucose-lowering medications, meal pattern, physical activity, and in patients with renal impairment or hepatic impairment or hypoglycemia unawareness.

    Severe, life-threatening, generalized allergy, including anaphylaxis, generalized skin reactions, angioedema, bronchospasm, hypotension, and shock may occur with any insulin.

    The most common adverse reactions associated with Tresiba and Ryzodeg in clinical trials were hypoglycemia, allergic reactions, injection site reactions, pitting at the injection site (lipodystrophy), itching, rash, edema, and weight gain.

  • November 4, 2015

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