Journal of Pharmacy Technology

To determine local pharmacists' willingness to recommend/allow the use of OTC ibuprofen when prescription-strength ibuprofen had been prescribed for symptomatic relief of rheumatoid arthritis, to examine the evidence-based medicine supporting the use of ibuprofen for rheumatoid arthritis treatment, and to determine the impact this evidence has for nonprescription ibuprofen drug labeling.

Sixty community pharmacies in the southeastern US were surveyed via the “shopper” method. Then a literature search was conducted using MEDLINE (1966–June 2003), International Pharmaceutical Abstracts (1970–June 2003), Current Contents (1966–June 2003), Lexis-Nexis (2001–2003), and Cochrane Database of Systematic Reviews (2000–June 2003). Articles that examined the efficacy and safety of low-dose ibuprofen (<400 mg every 4–6 h not to exceed 1200 mg/day) were reviewed. Clinical practice guidelines were obtained to determine the standard of care for rheumatoid arthritis treatment.

All pharmacists stated that it was completely acceptable to substitute OTC ibuprofen for the prescription formulation. Little to no counseling occurred at the point of service. These recommendations do not coincide with clinical practice guideline recommendations for the use of nonsteroidal antiinflammatory drugs versus disease-modifying antirheumatic drugs for long-term rheumatoid arthritis treatment.

Results of this survey and literature review suggest the need for nonprescription educational initiatives regarding the role of nonprescription analgesics geared toward pharmacists. Clarification from the FDA as to the role of nonprescription drug therapy for chronic disease states is needed.

Digoxin is distributed in skeletal muscles in high concentrations. The most reliable parameter to measure the distribution of digoxin in patients undergoing hemodialysis is not known.

To estimate which distribution parameter—estimated lean body mass (E-LBM) calculated by subtracting the fat mass from the dry weight, lean body mass, dry weight, and ideal body weight—is the most reliable predictor for assessing the accuracy of a digoxin dosing regimen in patients undergoing hemodialysis.

A retrospective study was conducted to evaluate 21 patients undergoing hemodialysis who were administered digoxin. The patients were divided into 2 groups: digoxin 0.125 mg administered twice a week (low-dose group) or 3 times per week (high-dose group). The differences between E-LBM, lean body mass, dry weight, and ideal body weight for the low- and high-dose groups were determined. The relationships between serum digoxin concentrations and the weekly digoxin dose per E-LBM, lean body mass, dry weight, and ideal body weight were also determined.

E-LBM, lean body mass, dry weight, and ideal body weight in the high-dose group were significantly larger than those in the low-dose group (p = 0.021, 0.015, 0.024, and 0.0029, respectively), although no significant difference in serum digoxin concentrations was evident. Significant correlation was found between serum digoxin concentrations and the weekly digoxin dosage per E-LBM, dry weight, lean body mass, and ideal body weight (r = 0.746, p < 0.0001; r = 0.638, p = 0.0014; r = 0.645, p < 0.0011; r = 0.553, p = 0.0083, respectively).

E-LBM appears to reflect the best parameter for predicting serum digoxin concentrations. The use of the dry weight parameter could be generally useful for adjusting the dosage of digoxin in patients undergoing hemodialysis.

To describe the effect of low-dose subcutaneous octreotide on refractory diarrhea associated with capecitabine.

A 67-year-old white woman with recurrent metastatic breast cancer received monotherapy with capecitabine after failing docetaxel. The first 2 consecutive capecitabine cycles were well tolerated. The patient, however, developed severe watery diarrhea after the third cycle. Diphenoxylate, atropine, loperamide, and attapulgite, along with conventional supportive measures, did not significantly improve the diarrhea, resulting in prolonged hospitalization. Octreotide 100 μg every 8 hours was administered subcutaneously. Immediate relief in stool frequency was observed during the first day. The stool became more formed on the next day. The patient was ready for discharge after learning how to perform subcutaneous injections. Octreotide was continued at home for 3 more days. After discontinuation of octreotide, no recurrent diarrhea occurred. Capecitabine was not reinitiated.

Diarrhea is a potentially life-threatening complication from treatment with capecitabine, an oral fluoropyrimidine analog. Octreotide has shown efficacy for diarrhea from many conditions, including chemotherapy with irinotecan and intravenous fluoropyrimidines such as fluorouracil. Our report suggests that octreotide also is effective for diarrhea associated with capecitabine. The patient's rapid response shortened her hospital stay and improved her quality of life.

In our patient, subcutaneous octreotide, along with other conventional antidiarrheal therapies, was associated with rapid resolution of refractory diarrhea attributed to capecitabine.

To describe the role of valacyclovir in the treatment of acute herpes zoster pain and its effect in postherpetic neuralgia.

A literature search was conducted on MEDLINE (1980–October 2003). Search terms included valacyclovir, postherpetic neuralgia, treatment, acyclovir, and valacyclovir.

Articles describing use of valacyclovir in the treatment of herpes zoster, with focus upon alleviation of acute zoster pain and postherpetic neuralgia, and articles describing use of valacyclovir for this indication in comparison with other antivirals were evaluated.

Four studies discussing the use of valacyclovir in the treatment of herpes zoster with focus on herpetic pain and postherpetic neuralgia were identified. All of these studies reported that valacyclovir is an effective treatment for herpes zoster and alleviates associated pain significantly faster than acyclovir, presumably due to its greater bioavailability. Valacyclovir likely results in a higher adherence rate than acyclovir because it is dosed 3 versus 5 times daily. Interestingly, the severity of pain was not significantly different between the 2 treatments, only the duration. Finally, one study showed that valacyclovir is equally as effective as famciclovir in alleviating pain associated with herpes zoster.

Valacyclovir 1 g given orally 3 times a day for 7 days is effective in the treatment of herpes zoster. It is superior to acyclovir 800 mg given orally 5 times a day for 7 days and equivalent to famciclovir 500 mg given orally 3 times a day for 7 days in alleviating acute zoster pain and postherpetic neuralgia.