PROLONG (I'm damn patents and health spending)
Monday, December 6, 2010
After Prom Hotel Rentals
In line with a previous post in which we help to clarify our questions about the peculiar use of psychotropic drugs (zonisamide , at that time), we now raise new questions that haunt us about another drug belonging to our insurance and effective armamentarium: the seroquel of AstraZeneca (today seroquel prolong , of \u200b\u200bcourse).
Our story begins long ago, back around 2000 or so, when we began to introduce the third atypical antipsychotic of the Modern Era (at that time, the sertindole had died of heart problems, although some sources tell us that he has been seen recently become zombie and achieving increased sales ...). Well, when we were presented seroquel (quetiapine as active) lab helped our training with scientific studies that spoke of doses ranging from 350 to 750 mg / d (quoted from memory). We began to prescribe it (there were more gullible back then) and that not throw or pa ` behind ... Soon, the medical interviewers we clarified the problem had to be reached much higher doses of 1200 or 1500 mg / d, and even I had professional cases exceeded 2000 mg / d (not that it took them clarified, but it dose prescribed to patients close to triple what it pointed to the sheet).
The fact is that, at least in our environment and to our knowledge, the drug never succeeded.'re Not saying that to be effective as others, but our impression is that is slower, you have to climb much the dose that causes sedation and hypotension with some frequency ... Come on, We see no clear reasons to use ahead of others, such as risperidone it is also cheaper ... Although we review one exception: we have found a useful option in patients with Parkinson's disease, and causing very few extrapyramidal side effects.
And with the passage of time, we were seeing not without some wonder how he would prescribe the seroquel as a hypnotic or anxiolytic in non-psychotic patients. Completely unaware what type of review may recommend such use. We understand that in cases of insomnia or severe anxiety may be appropriate when a neuroleptic reassuring because of its greater power against a benzodiazepine, but have known for decades and drugs very cheap such as Sinogan (levomepromazine ) or largactil ( chlorpromazine), what may be the reason for using a drug much more expensive, much less studied and, at least in our opinion, less effective than the previous ones to those indications and no better tolerated than them? See if someone explains it to us, that we give more laps than him ... not finished
has also won its use in patients with dementia to control agitation. Interestingly, a Cochrane Review 2008 on the use of atypical antipsychotics in dementia is that risperidone and olanzapine are effective for aggression and risperidone only for psychotic symptoms, but these are associated with increased risk of stroke . The rest of atypical, there is insufficient data to recommend them. The review also refers to a meta-analysis that found increased mortality associated with use of atypical antipsychotics in patients with dementia. "Based on what information is extending its use in this indication? (I really do not know, if someone does get us would be most grateful, as usual). And do not say, because it seems that there are no studies that they claim that classical antipsychotics are free of problems in this group of patients but if atypicals are no better and are more expensive, why use them?. Because the criterion for using quetiapine may not be well tolerated in the short term if its efficacy is not clear and no long-term security because, for that matter, the water is better tolerated and it is free and safer ...
not want to end our discussion on seroquel without reference to settlement reached by AstraZeneca to pay $ 198 million of 17,500 lawsuits filed by people who suffered diabetes during treatment with seroquel , without the company had adequately warned that risk. There are still 8,500 claims are pending trial. Anyway, for those who worry about the future of the pharmaceutical industry as we know, a figure that will reassure them: total sales seroquel in 2009 amounted to 4,900 milion dollars.
As you can see light and dark in relation to seroquel (in our opinion, rather tending to dark, dark ...) but recently off patent and think, well, at least now with the advent of generic formulations, will be cheaper to afford the treatments. And then witnessing the advent of seroquel prolong .
As its name suggests, this is -ar prolong the patent to increase profit ... Ah, no! What was I thinking? ... This is, we wanted to say that the release is longer and simply administer once daily. Obviously, this is a dosage more comfortable, although we believe the issue is whether the convenience justifies the price increase by the public purse, in addition to times economic prosperity as we enjoy do not know how long ... Quetiapine generic worth about 120 euros monthly dose of 800 mg / d per patient, while the seroquel prolong ( extended release quetiapine), about 170 euros.
And the fact is that we understand that patients will comply with the treatment well prolong and not two or three daily doses of other treatment would be fully justified (if previously and justified the use of quetiapine over another antipsychotic). But do not understand why it is prescribed for patients who are good performers, or for patients living in nursing homes where they are given medication, or for patients undergoing other treatments that do take two or three times a day ...
And we have seen cases picturesque (expensive for the health system, but picturesque) prescribing the seroquel prolong twice-daily or even three ... And cases surreal (expensive for the health system, but surreal) to prescribe seroquel prolong as hypnotic. Regardless of little sense to use a drug for insomnia sedative effect of which lasts 24 hours, do not understand why not to use drugs as Sinogan , for example, if a benzodiazepine hypnotic is not enough or not indicated ... The same could be said of its use as an anxiolytic ...
Finally, we do not get tired (more). It turns out that our doubts about the appropriateness of prescription seroquel prolong for more than to swell the coffers of AstraZeneca and have satisfied the representative of the case (Honolulu must be so nice ...) are not only ours. The Health Service the Balearic Government in a Medicines Evaluation Report reads: poses no therapeutic advance .
Well, that's all for today. We're going to buy camouflage uniforms because, between how we carry health spending and how the government takes the budget deficit, militarized gives us a moment's notice.
Subscribe to:
Post Comments (Atom)
0 comments:
Post a Comment