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Dual Eligibles SFY2004 Total Total Total Total Allowed Number Number Of Quantity Ingredient of Claims Recipients Paid Amount 155 38 2, , 285.79 66 13 , 623.82 184 31 , 889.38 284 42 , 630.75 83 17 , 101.93 19 4 6.02 13 12 406 .84 30 25 812 .72 86 77 2, 1.59 200 154 5, 4.35 78 66 2, 7.54 744 562 20, , 828.38 2 .35 16 12 580 .97 4 128 .42 24 23 678 3.87 7 6 289 .74 2 80 .28 69 47 2, 6.70 5 174 .92 2 1 60 ##TEXT##.50 3 1 300 , 083.00 4 1 0.32 1 30 .71 1 28 .15 9 8 136 5.13 1 5 .13 1 492 .15 3 1 15 8.64 3 1 90 .09 2 1 100 .26 1 100 .96 18 4 1, 6.84 59 10 1, .60 3 1 270 3.27 Page 335 Total Dispensing Fee Amount 2.10 7.25 0.65 , 014.70 5.65 .35 .45 9.50 3.90 6.35 4.70 , 708.30 .30 .40 .60 .95 .55 .30 8.20 .95 .30 ##TEXT##.00 ##TEXT##.00 .65 ##TEXT##.00 .20 .65 ##TEXT##.00 .95 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 5.35 .65 .95 Total Reimbursed Amount , 813.70 , 824.39 , 482.29 , 643.45 , 748.15 3.25 .81 1.22 1.33 , 177.30 0.90 , 489.40 .65 4.20 .02 7.56 .29 .58 4.90 .87 .80 , 062.00 0.32 .36 .15 2.33 .78 .96 9.59 .04 .26 .96 6.84 , 532.46 .25 4.22 Total Copay Amount .00 ##TEXT##.00 ##TEXT##.00 .00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 .00 ##TEXT##.00 .00 ##TEXT##.00 .00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 .00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00 ##TEXT##.00. References and Resources : gastromd education gerd : aboutgerd treatment : oregonrx OHPPRREPORTS VHA pharmacy Benefits management strategic healthcare group and the medical advisory panel. Abbreviated drug class review. Proton Pump Inhibitors. Available on line at vapbm reviews ppiabbreviatedreview AstraZeneca. Prilosec OTC printable label on-line ; . Available at prilosecotc hcp prilosec label image AstraZeneca. Prilosec package insert on-line ; . Available at astrazeneca-us pi prilosec Kremers Urban. Omeprazole package insert on line ; . Available at ppiq pdf omeprazolepi AstraZeneca. Nexium package insert on-line ; . Available at astrazeneca-us pi nexium TAP. Prevacid package insert on line ; . Available at prevacid prescribing information Wyeth Laboratories. Protoniix package insert on line ; . Available at wyeth content ShowLabeling ?id 135 Eisai Janssen. Aciphex package insert on line ; . Available at aciphex aciphexpi Byrne MF and Murray FE. Formulary Management of Proton Pump Inhibitors. Pharmacoecon 1999; 16 3 ; : 225-46. Richardson P, Hawkey CJ, Stack WA. Proton Pump Inhibitors: Pharmacology and Rationale for Use in Gastrointestinal Disorders. Drugs 1998; 56 3 ; : 307-35. Gerson LB and Triadafilopoulos G. Proton Pump Inhibitors and their drug interactions: an evidence based approach. Eur J Gastroent Hepatol 2001; 13: 611-6. Labenz J, Petersen KU, Rosch W, Koelz HR. A summary of food and drug administration-reported adverse events and drug interactions occurring during therapy with omeprazole, lansoprazole, and pantoprazole. Aliment Pharmacol Ther 2003; 17: 1015-9. Bianchi PG, Lazzaroni M, Imbesi V et al. Efficacy of pantoprazole in the prevention of peptic ulcers induced by non-steroidal antiinflammatory drugs: a prospective, placebo-controlled, double-blind, parallel-group study. Dig Liver Dis 2000; 32: 201-8. Kaviani MJ, Hashemi MR, Kazemifar AR et al. Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized clinical trial. Aliment Pharmacol Ther 2003; 17: 211-6. Kearns GL and Winter HS. Proton pump inhibitors in pediatrics: relevant pharmacokinetics and pharmacodynamics. J Ped Gastroenterol Nutr 2003; 37: S52-9. Colleti RB and Di Lorenzo C. Overview of pediatric gastroesophageal reflux disease and proton pump inhibitor therapy. J Ped Gastroenterol Nutr 2003; 37: S7-11. Multiple authors have proposed that men with PE have hypersensitive penis' and either reach ejaculatory threshold more rapidly or have a lower ejaculatory threshold than men with normal ejaculatory control [91, 102-104]. A limitation of the universal applicability of this theory is its inability to explain acquired PE. Xin et al. demonstrated that men with early ejaculation have lower biothesiometric vibration perception thresholds and significantly shorter mean somatosensory evoked potential latency times of the glans and penile shaft than controls [82, 105]. Paick et al. and Rowland, however, were unable to reproduce these findings, reporting no significant statistical differences between normal controls and patients with primary early ejaculation [81, 106]. Several authors have reported that penile sensitivity reduces with ageing [104, 107, 108]. This is probably due to loss of the fastest conducting peripheral sensory axons from the third decade, dermal atrophy, myelin collagen infiltration and pacinian corpuscle degeneration [106]. Some researchers have suggested this observation as the reason why PE is reported more often in younger men [90]. However, a more attractive explanation of this observation is the presence of greater anxiety and less frequent sexual activity in the absence of a long-term relationship resulting in fewer sexual opportunities to learn ejaculatory control. Fanciullacci et al. measured significantly higher amplitude cortical somatosensory evoked potentials following penile electrical stimulation in men with severe lifelong PE compared to control subjects [109]. They hypothesized that men with PE have a greater representation of the penile sensory nerve supply in the cerebral cortex than controls, and suggested this as an indication of an organic basis for PE. Consistent with this is the report by Bradley that the cortical distribution of the dorsal nerve of the penis is larger in men with lifelong PE [110]. Brain imaging with functional MRI and positron emission tomography is required in humans to identify the central control of the ejaculatory process in man.
Genic bladder or an immunocompromised state. Data were reviewed and standard descriptive statistics were utilized. RESULTS Patient characteristics One hundred and twenty patients met study criteria. Forty-eight patients 40% ; were aged 1 month to 1 year. There were 30 males and 18 females, giving a male to female ratio of 1.7: 1. Above 1 year of age, the sex ratio was reversed and female to male ratio varied from 1.7-3.2: 1 Table 1 ; . A history of chronic constipation was detected in 22 patients 18.3% ; . Of these, 6 were males and 16 were females. Family history of renal disease or UTI was not found in this study population. Symptoms at presentation Fever 38 C ; was the major symptom of UTI occuring in 96 patients 80.0% ; . Eleven cases with fever developed febrile seizures. The second most common symptom was dysuria 26.7% ; . Twentyseven patients 22.5% ; presented with abdominal pain, vomiting and diarrhea. Gross hematuria was the initial presentation in 5 patients 4.2% ; Table 2 ; . The mean.
Children with cerebral palsy and or other disorders associated with hyper- or hypotonia are at increased risk for obstructive sleep apnea. In fact, the child with cerebral palsy may be at greater risk for obstructive sleep apnea because of the inability to reposition during apneic events. Furthermore, the restrictive lung disease associated with scoliosis and limited range of motion of the torso further limit pulmonary function, placing the child at increased risk for obstructive sleep apnea. Although the diagnosis may be suspected clinically, it is validated by polysomnography. During polysomnography, sleep staging is made with electroencepholography measures. Airflow, oxygen saturation, respiratory excursion and carbon dioxide levels are monitored. Treatment may be as easy as a tonsillectomy and adenoidectomy. Some children with moderate to severe obstructive sleep apnea are significantly better after treatment with continuous positive airway pressure CPAP ; . CPAP treatment may lead to increased ability to participate in therapies, school and family social activities. Parasomnias describe a group of behaviors that are usually attributed to wakefulness that persists in sleep. Almost any automatic behavior done during the day may manifest in sleep as a parasomnia. Examples include sleep walking somnambulism ; , enuresis, nocturnal sleep eating and confusional arousals. Confusional arousals may have an associated emotional component that has earned them the name "night terrors, " probably because they terrify the parent more than the child. The child is often amnesic of the nocturnal event. A child, bright-eyed and ready for breakfast, may awaken to find his parents terribly worried. A polysomnogram is generally not necessary for parasomnias. Treatment with clonazepam is reserved for children who have injured themselves or whose parents are so tired by the frequent nocturnal events that they find daytime functioning difficult. Differentiating parasomnias from nocturnal seizures can be difficult. Generally seizures are stereotypic, paroxysmal and abnormal behaviors. Children may exhibit repetitive or stereotypic behaviors or postures. If the child is consistently more tired the morning after a nocturnal event, suspicion of nocturnal seizures may be increased. In cases where nocturnal seizures are suspected, a polysomnogram with EEG montage is indicated.
Increased by 69 percent due to the addition of Pfizer's Caduet. Spending cuts on Aciphex, Nexium, Prevacid and Protomix resulted in a drop from 3rd to 7th for Proton Pump Inhibitors, and the Seizure Disorder class slipped from 6th to 8th, even though ad outlays increased by 13 percent. The introduction of Cialis advanced the Sexual Function Disorders category from 35th to 9th, while Angiotensin II Teceptor Blockers, Alone slipped from 7th to 10th. Extended Spectrum Macrolides climbed from 22nd to 13th on a 70 percent increase in ad outlays due mostly to Pfizer's Zyvox. The Interferon category, new to the top 25, climbed from 26th to 15th following a 52 percent increase in ad expenditures due largely to Peg-Intron and Betaseron. Others new to this year's list include Cancer Therapy Products, up from 46th to 20th, Oral Contraceptives, Estrogen with Progestogens, up from 43rd to 22nd due mostly to Barr's Seasonale, and Antivirals, Other which climbed from 64th to 23rd due in large part to Reyataz, Valcyte and Valtrex. Also advancing were Quinolones, Systemic, from 42nd to 24th due largely to Ciprodex, Levaquin and Leva-Pak, and Cephalosporins and Related, 57th to 25th due mainly to Purdue's Spectracef and ranitidine.
Who Gets ZES? The incidence of ZES in the United States is estimated at one case per million people per year, and at 0. 1% to 1% among patients with peptic ulcers. The mean age at onset is 45 to years, and men are affected more often than women. How Is ZES Diagnosed? ZES should be suspected in patients with ulcers who are not infected with H. pylori and have no history of NSAID use. Diarrhea may precede ulcer symptoms. Ulcers occurring in the second, third, or fourth portions of the duodenum or the jejunum the middle section of the small intestine ; are signs of the syndrome. Gastroesophageal reflux disease backflow of the stomach's contents into the esophagus ; is more prevalent and often more severe in patients with ZES, and can be complicated by ulcerations and strictures of the esophagus. How Is ZES Treated? Peptic ulcers associated with ZES are typically persistent and difficult to treat. Treatment consists of removing the tumors and suppressing acid with intravenous proton-pump inhibitors Portonix ; . Proton-pump inhibitors block acid production and are a major advance for these patients. Previously, removing the stomach was the only option.
Nose irritation due to an infection might cause this problem or they may have an allergy and prevacid. Protonix cureIn some instances, a therapeutically equivalent prerequisite medication may be required to be tried before other medication is approved. This is called step therapy. Drug categories or medications that require step therapy include, but are not limited to: Proton Pump Inhibitors PPIs such as Nexium, Protonis and Aciphex ; Cox II inhibitors i.e., Celebrex and Bextra ; Stadol Leukotrienes. GENERIC PRODUCTS ADDED Brand products in parentheses ; are non-formulary and listed for reference only alendronate tabs FOSAMAX ; cefuroxime susp CEFTIN ; chlorzoxazone tabs diclofenac sodium ophth soln VOLTAREN ; flunisolide nasal soln NASAREL ; loxapine caps LOXITANE ; nambumetone tabs norethindrone acetate ethinyl estradiol iron tabs Tilia Fe, Tri-Legest Fe ESTROSTEP FE ; BRAND PRODUCTS ADDED INTELENCE etravirine tabs ; OXYCONTIN oxycodone extended-release tabs ; STALEVO carbidopa levodopa entacapone tabs ; VANTAS histrelin implant ; GENERIC PRODUCTS ADDED Brand products in parentheses ; are also on formulary pantoprazole delayed-release tabs PROTONIX ; ramipril caps, 2.5 mg, 5 mg, 10 mg ALTACE and prednisolone. A meta-analysis of placebo-controlled trials of valdecoxib Bextra, Pfizer ; used for either pain control in patients undergoing coronary artery bypass graft CABG ; surgery or in patients with arthritis indicates an increased risk of major adverse cardiovascular events associated with the COX-2 inhibitor. Preliminary data from the meta-analysis were released by Garret FitzGerald, MD, at the American Heart Association AHA ; 2004 Scientific Sessions in New Orleans. The data suggest that increased cardiovascular risk may be a "class effect" among the COX-2 inhibitors, said Dr FitzGerald, professor of cardiovascular medicine and pharmacology, University of Pennsylvania, Philadelphia. The total number of patients in the meta-analysis was 7, 771, of which 2, 098 were patients randomized to valdecoxib for pain control or placebo to the withdrawal of rofecoxib from in approximately a 2: 1 ratio following the market.The increased relative risk CABG, and 5, 673 were patients with of confirmed cardiovascular events in arthritis who were randomized to patients taking rofecoxib in APPROVe valdecoxib n 4, 531 ; or placebo became apparent 18 months after ini n 1, 142 ; . tiation of treatment. The relative risk of A test for heteroI The data suggest myocardial infarction geneity found no sigthat increased or stroke in the valdenificant difference in coxib recipients was risk between patients cardiovascular risk 2.19 95% CI: enrolled in the CABG may be a "class 1.194.03 ; . By comtrials and those eneffect" among the parison, the relative rolled in the arthritis risk associated with rotrials, according to Dr COX-2 inhibitors. fecoxib Vioxx, FitzGerald.The trials Merck ; was 1.96 in the of CABG patients proAPPROVe Adenomatous Polyp Previded the first indication of a cardiovasvention on VIOXX ; trial. It was this cular risk associated with valdecoxib. trial, designed to investigate the effica"The clustering of these events in cy of rofecoxib in the prevention of CABG patients is exactly the sort of colorectal polyps in patients with a his- signal we would be concerned about, " tory of colorectal adenomas, that led he said. An early cardiovascular signal is more likely to be picked up in CABG patients because their hemostatic syscal assistance. The company stated that Revised labeling issued for valdecoxib tem is activated. the breakage is not a result of a quality Bextra, Pfizer ; includes a warning of the The data from the meta-analysis issue with the product, but it risk of a rare but serious skin aren't as reliable as those from a does pose a potential safety reaction that may occur in paprospective randomized controlled concern. tients receiving the drug, study such as APPROVe, Dr FitzGermainly within the first 2 weeks ald cautioned. Nevertheless, the metalabeling updates Warnings of increased risks of therapy. analysis carries a different weight in of QTc prolongation and tor& new light of the APPROVe trial outcomes. sades de pointes in geriatric The labeling for adalimumab warnings patients and rhabdomyoly Humira, Abbott ; was revised "The context has shifted, " he said. "It to include warnings regarding sis in the general patient speaks to the issue of a class effect.We reports of anaphylaxis and hematologic population were added to the labeling have clear mechanisms to explain why events such as cytopenia and pancytopefor levofloxacin Levaquin, Ortho-McNeil ; . it happened.The burden of proof has nia in patients receiving the drug. A warnAdditional information was also added now shifted, and there is good evidence ing of serious infections in patients reto the peripheral neuropathy and tendon that cardiovascular risk will be inceiving concomitant anakinra with another effects subsections, and quinolone class creased with all drugs in this class." TNF inhibitor similar to adalimumab was labeling information will be added to the Patients with cardiovascular disalso included in the revised labeling. drug's prescribing information. ease probably should not be taking a COX-2 inhibitor, according to Dr The manufacturer of intravenous pantoLabeling revisions were approved for peniFitzGerald. prazole Protonix IV, Wyeth ; issued a "Dear cillamine Cuprimine, Merck ; to include In response to the meta-analysis Health Care Professional" letter regardwarnings of impaired renal excretion in ing reports of glass vial breakage with the geriatric patients. The labeling now also results, Pfizer said that conclusions drug during attempts to connect the vials includes warnings regarding the risk of regarding the cardiovascular safety of to spiked IV system adaptors during manmutagenic effects on the fetus when the valdecoxib were "unsubstantiated" and ual assembly and while utilizing mechanidrug is used in pregnant women. based on information not yet subject to independent scientific review. F. A : Okay, next question. Operator: Our next question is from Tim Anderson with Prudential Securities. Please go ahead. Q Timothy Anderson : Thank you. A couple of questions. Can you kind of give us an update how you plan to defend Effexor versus Cymbalta apart from adding more reps, what are going to be the key differentiating points in favor of Effexor in terms of product profile as you see everything shaping up today and then on Protonix, is the rebating and discounting just to clarify that is fully reflected in the sales this quarter and do you expect any further increase in rebates or discounts in the future or are we pretty much done with that revision? A : Okay, Tim, before I turn it over to Bernard let me just say that obviously, you know, we have marketing plans and we have a way that we consider that we should market our products and defend against competitors and we're not going to be all that forthcoming yet because, first of all, Cymbalta is not even on the market and we don't know when it's going to be on the market, we don't even know what the exact profile of the product is going to be so we're limited in how we're going to answer that question but if Bernard would like to make a general comment and then answer your second question, I would turn it over to him. A Bernard Poussot : Okay, on the Cymbalta front we have been waiting for Cymbalta now for a while, and the points are that, we have seen the studies published largely at BID dosage and, you know, Effexor in contrast offers very good efficacy and safety in depression at once a day so we're very encouraged by that. We are ready. I mean we have, you know, prepared for this introduction and we are confident that we can continue to sustain a growth higher than the market going forward. On Protonix for the rebates, my answer is that the quarter reflects, you know, both our volume development and our rebates and, as I said, you know, they are obviously complementary to each other but these are the numbers I mentioned earlier. w w w Cal l Street. co m 212. 931. 6 Copyri ght 2004 Cal l St reet 10.
The American Society of Health-System Pharmacists ASHP ; issued a drug shortage Group, 2004 bulletin for Protonix iv in September 2004. The bulletin noted that Wyeth had discontinued production of the old formulation of Protonix iv that required use of an in Commercial and Pipeline Perspectives: Upper GI Disorders.
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