Pharmacy News
Bisphosphonates (such as Fosamax™) are used to treat osteoporosis in postmenopausal women. Reports of osteonecrosis of the jaw (ONJ; “dead jaw”) related to the use of bisphosphonates are appearing at an alarming rate. ONJ is a slow death of bone tissue that occurs because of poor blood supply to the bone, as bisphosphonates prevent replacement of the jaw’s old bone cells with new cells that are important for adequate blood supply. The deterioration is painful and often characterized by mouth swelling, loosening of teeth and exposed bone. Sometimes, the problem is not discovered until the person has dental work involving the bone that does not heal, which may lead to jaw fracture or require long-term antibiotic care or surgery. Patients using bisphosphonates intravenously, or who have undergone chemotherapy, have a history of cancer, Paget’s disease or osteoporosis, use steroids while on alendronate, or have a history of major dental work are at an increased risk for ONJ. Early diagnosis might prevent or reduce the problems caused by advanced destructive lesions of the jaw bone. While osteonecrosis can be managed, it is irreversible. Other options are available to treat and prevent osteoporosis. Ask our compounding pharmacist for more information.
Bio-identical Hormone Replacement Therapy (BHRT) is an option for prevention and treatment of osteoporosis.
Compounding pharmacists work together with women and their health care providers to individualize therapy and meet specific needs.
January 30, 2007
Copyright 2007, Storey Marketing - Monthly Website Updates. All rights reserved. Questions regarding this article should be directed to the compounding professionals at Central Pharmacy.
Recurrent urinary tract infections are a problem for many postmenopausal women. Estrogen replacement restores deteriorating mucosa (lining of the vagina), lowers vaginal pH, and may prevent urinary tract infections. Ninety-three postmenopausal women with a history of recurrent urinary tract infections participated in a randomized, double-blind, placebo-controlled trial of a topically applied intravaginal estriol cream. The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo (0.5 vs. 5.9 episodes per patient-year). Lactobacilli (bacteria which are normally present in a healthy vagina and help to keep infection-causing bacteria in check) were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women but in none of the 24 placebo recipients. With estriol, the mean vaginal pH declined to normal.
To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women, 88 postmenopausal women with urogenital aging symptoms were enrolled in a prospective, randomized, placebo-controlled study. Women in the treatment group received intravaginal estriol 1 mg once daily for 2 weeks and then 2 mg once weekly for a total of 6 months as maintenance therapy. After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group.
Younger women taking oral contraceptives can suffer from similar symptoms. Thirty women (mean age 22.7 years) with a long-standing history of recurrent urinary tract infections received vaginal estrogen therapy consisting of 1mg estriol (E3) daily for two weeks and twice a week for two additional weeks. In the follow-up period of 11 months after treatment, 24 of 30 patients reported no symptoms of bladder infection and used no additional medication.
Copyright 2006, Storey Marketing - Monthly Website Updates. All rights reserved. Questions regarding this article should be directed to the compounding professionals at Central Pharmacy.
Low serum testosterone (clinically referred to as hypogonadism) is commonly associated with erectile dysfunction (ED). There are merits to treating hypogonadism versus prescribing oral phosphodiesterase (PDE-5) inhibitors (such as Viagra™, Cialis™, and Levitra™) for sexual dysfunction. Testosterone-replacement therapy (TRT) may be the best treatment for men with ED when the presentation includes diminished libido or other sexual symptoms or when non-sexual symptoms such as depressed mood, decreased sense of vitality, and increased fatigue also exist. The health benefits of TRT also include improvements in body composition, bone density, cognition, and sense of well-being. Thus, there may be good reasons to use TRT as first-line therapy for the man with ED. Concerns regarding prostatic and cardiovascular risks of TRT have not been supported by the medical literature. Nevertheless, men receiving TRT must be monitored at regular intervals with digital rectal examination and blood testing for prostate-specific antigen. Hematocrit or hemoglobin also should be obtained regularly due to the risk of erythrocytosis. Awareness of the benefits of TRT in the man with ED may improve clinical outcomes.
Current Urol Reports 2005 Nov;6(6):476-81
According to the Department of Urology, Columbia University, New York, NY, there are benefits to using a combination of testosterone and PDE-5 inhibitors. A recently published multicenter, randomized, placebo-controlled study evaluated the safety and efficacy of testosterone gel 1% plus sildenafil (Viagra™), vs. placebo gel plus sildenafil, in producing an erectile response in men with low serum testosterone who had not responded to treatment with sildenafil alone for ED. Therapy with testosterone gel significantly improved erectile function in response to sildenafil. The combination therapy also significantly improved orgasmic function and patient satisfaction.
J Sex Med 2005 Nov;2(6):785-92
For more information, please ask our compounding pharmacist.
Copyright 2006, Storey Marketing - Monthly Website Updates. All rights reserved. Questions regarding this article should be directed to the compounding professionals at Central Pharmacy
Four years ago, the Women’s Health Initiative (WHI) suggested that taking synthetic hormones, which are primarily manufactured by the “Big Pharma” company Wyeth, could lead to an increased risk of breast cancer and heart problems. In response, many physicians ceased to prescribe conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) and a combination of the two hormones. Wyeth’s sales of these products decreased significantly. Many women who feared the risks or had previously experienced side effects after taking commercially-manufactured hormones or sought individualized alternatives to “one size fits all” hormone replacement therapy (HRT) turned to Bio-identical HRT (BHRT). In response, Wyeth has filed a complaint with the federal Food & Drug Administration asking it to take action against small pharmacies that compound bio-identical hormones.
“While Wyeth clearly expected to improve its position in the multibillion-dollar market for women's hormonal products, the episode thus far shows signs of having the opposite effect. The FDA has yet to rule on Wyeth's complaint, but the huge corporation has stirred up a hornet's nest of opposition from women and doctors around the country, who see it as a classic case of Big Pharma throwing its weight around against small businesses and seeking to remove an important element of choice for suffering patients.”1 The FDA has not made a decision on the Wyeth petition, but has provided a site where patients and health care professionals can post comments and express their desire to stop pharmaceutical manufacturers from limiting prescribing options. Visit www.iacprx.org for a link to the FDA to take action. The comment period is expected to end May 4, 2006.
The WHI reported that the use of CEE alone increases the risk of stroke, decreases the risk of hip fracture, and does not affect the incidence of heart disease in postmenopausal women with prior hysterectomy over an average of 6.8 years. More detailed analysis has concluded that treatment with CEE alone for 7.1 years does not increase breast cancer incidence in postmenopausal women with prior hysterectomy. However, the researchers recommended that women who take CEE should have more frequent mammography screening and short interval follow-up. The authors of the review noted that initiation of hormone replacement should be based on consideration of the individual woman's potential risks and benefits.
The WHI trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms. These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.3
For more information about the benefits of individualized Bio-identical Hormone Replacement Therapy, please contact our compounding pharmacist.
DID YOU KNOW:
• Cholesterol lowering drugs called “statins” (Lipitor, Zocor, Pravachol, Mevacor) can cause muscle aches and/or joint pain (myopathy). Contact your physician if you are experiencing any unexplained aches and pains or weakness while taking this type of drug. A blood test can be performed to see if the drug is causing this condition.
• The FDA will likely pull Primatene Mist off the market this summer due to the ban on CFC propellants. It could take up to 5 years to reformulate and approve a new version. Speak to your doctor about prescription Alupent if you are using the Primatene Inhalers for relief.
• A new non-prescription weight loss pill could be approved by this summer. Alli (pronounced Al-eye) will be the OTC version of Xenical at half the strength. This drug works in your digestive tract by blocking about 1/3 of the fat in the food you eat from being digested. This undigested fat passes through your system cannot be absorbed and is eliminated.
• The recommended doses for people with ostoporosis are:
Elemental Calcium -1000-1500mg/daily—this should be in the form of Calcium Citrate which is absorbed by the body much better that Carbonate (especially in elderly patients with decreased stomach acid or people taking H2 blockers),
Vitamin D – 800iu per day
Magnesium – 400 to 800mg per day |
