Archive for February, 2008

Tysabri (natalizumab) and liver injury

admin February 28th, 2008

FDA news:

Biogen Idec, Elan and FDA notified healthcare professionals of reports of clinically significant liver injury, including markedly elevated serum hepatic enzymes and elevated total bilirubin, occurred as early as six days after the first dose of Tysabri. The combination of transaminase elevations and elevated bilirubin without evidence of obstruction is recognized as an important predictor of severe liver injury that may lead to death or the need for a liver transplant in some patients. Tysabri should be discontinued in patients with jaundice or other evidence of significant liver injury. Physicians should inform patients that Tysabri may cause liver injury.

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Patient reporting of adverse drug reactions

admin February 18th, 2008

The BBC report on the MHRA’s drive to increase public participation in The Yellow Card scheme.

Dr June Raine, from the MHRA, said: “We are keen to let people know that whilst their medicines have important benefits, they may also have unwanted side-effects.

“If you suspect that you have had a side-effect to your medicine, please tell us about it via the Yellow Card scheme.”

A spokesman for the MHRA stressed that they were interested to hear about any side-effect, including side-effects already mentioned by the doctor or covered by the drug packaging.

Here is the MHRA’s press release:

Members of the public to be encouraged by pharmacists to report suspected side effects of medicines

The Medicines and Healthcare products Regulatory Agency (MHRA) is today launching a six-week campaign to get community pharmacists to mention the Yellow Card (YC) Scheme when they talk to their customers about their medicines. During this week, pharmacists will receive an information pack containing updated Yellow Card reporting forms, information leaflets, and a new poster for display in the pharmacy. The Yellow Card reporting forms have been made simpler and easier to use than previous versions and an updated online system at www.yellowcard.gov.uk will make it quicker and easier to report suspected side effects of medicines to the MHRA.

Dr June Raine, Director of Vigilance and Risk Management of Medicines at the MHRA said, “We are keen to let people know that whilst their medicines have important benefits, they may also have unwanted side effects. If you suspect that you have had a side effect to your medicine, please tell us about it via the Yellow Card Scheme. Please speak to your local pharmacist if you need help to do this, as they can provide expert help and support. Please pick up and fill out our improved reporting form or go online and tell us about your experiences there. By providing this information, not only are we able to gain better insights into the safety of medicines, but you can directly become involved in medicines regulation.”

Shelley Flanagan, a member of the public who suffered side effects from antibiotics after being treated for pneumonia said, “I would encourage anyone who believes they have had a side effect to a medicine to fill out a Yellow Card like I did, or report online. I think it’s important to discuss the medicines you are taking with your pharmacist or doctor so that you understand what you are taking and why.”

Ends

Notes to Editor

1. Yellow Card reports are used to identify side effects and other issues with medicines which might not have been known before. If a new side effect is found, the MHRA will review the way that the medicine can be used, and the warnings that are given to people using it. The value of the YC Scheme has been demonstrated many times and it has helped to identify numerous important safety issues. It flagged up that Warfarin can interact with cranberry juice by lessening its benefits, and in 2001 Yellow Card reports identified that the smoking cessation medicine Zyban can cause seizures.

2. The MHRA typically receives around 20,000 Yellow Card reports of suspected side effects annually. It is encouraging to note that in recent years,Yellow Cards submitted by pharmacists have accounted for around 15-16% of all reports received. However, reporting by community pharmacists has not taken off in the way expected. In 2000, the first full year of community pharmacist reporting, they sent in just over 400 Yellow Cards – and this figure has remained fairly constant since then at around 300-500 reports per year. In contrast, the number of reports from hospital pharmacists has doubled (1300-1500 reports per year in recent years, compared with around 700 reports in 1998). Almost 7,000 patient reports have been received, this represents about 10% of the totality of reporting at a consistent level of over 200 reports per month.

3. For over 40 years, the Yellow Card Scheme has been the cornerstone of medicines safety monitoring in the UK. Since the Yellow Card scheme was set up, over 500,000 reports of suspected side effects (known as adverse drug reactions) have been completed.

4. The Yellow Card Scheme was set up in 1964 following the Thalidomide tragedy to provide a system for early detection of emerging drug safety hazards, and the routine monitoring for all medicines in clinical use. Reports of suspected side effects are also received from pharmaceutical companies, who have a legal obligation to report suspected serious side effects to the MHRA.

5. The MHRA is the government agency responsible for ensuring that medicines and medical devices work, and are acceptably safe. No product is risk-free. Underpinning all our work lie robust and fact-based judgements to ensure that the benefits to patients and the public justify the risks. We keep watch over medicines and devices, and take any necessary action to protect the public promptly if there is a problem. We encourage everyone –the public and healthcare professionals as well as the industry – to tell us about any problems with a medicine or medical device, so that we can investigate and take any necessary action. www.mhra.gov.uk

Severe reactions to Botox (botulinum toxins)

admin February 11th, 2008

FDA issued an early communication about an ongoing safety review regarding Botox and Botox Cosmetic. FDA has received reports of systemic adverse reactions including respiratory compromise and death following the use of botulinum toxins types A and B for both FDA-approved and unapproved uses. The reactions reported are suggestive of botulism, which occurs when botulinum toxin spreads in the body beyond the site where it was injected. The most serious cases had outcomes that included hospitalization and death, and occurred mostly in children treated for cerebral palsy-associated limb spasticity. Use of botulinum toxins for treatment of limb spasticity (severe arm and leg muscle spasms) in children or adults is not an approved use in the U.S

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Duphaston (dydrogesterone) withdrawal

admin February 5th, 2008

Duphaston is to be withdrawn for commerical reasons:

Duphaston/Duphaston HRT (dydrogesterone) is to be withdrawn from the market from March 2008 for commercial reasons.

Duphaston was licensed for use in several indications, including threatened or recurrent miscarriage, dysfunctional uterine bleeding, and hormone replacement therapy.

A Public Assessment Report available for download below reviews evidence for the efficacy of progesterone and dydrogesterone in the maintenance of pregnancy in women with threatened miscarriage or recurrent miscarriage.

For several decades, progesterone and progestogens (such as dydrogesterone) have been used to maintain early pregnancy.

The public assessment report is here [PDF].

Drug Safety Update February 2008

admin February 5th, 2008

The MHRA have published Drug Safety Update February 2008, including:

  • Statins: class effects identified
  • Varenicline: safety update
  • Carisoprodol and meprobamate: risks outweigh benefits
  • Yellow Card scheme update
  • Reporting by patients and the public
  • Biosimilar products
  • Duphaston/Duphaston HRT (dydrogesterone): withdrawal of Marketing Authorisation
  • Herbal safety news: OSAS (intensive body lotion with aloe vera) found to contain steroids
  • Rosiglitazone: new contraindications and warnings
  • Patient Information Leaflet of the month
  • Please report suspected counterfeit medicines
  • Midwife prescribing: public consultation

Varenicline – FDA Update

admin February 2nd, 2008

The FDA have updated the prescribing information for varenicline:

FDA informed healthcare professionals and consumers of important revisions to the WARNINGS and PRECAUTIONS sections of the prescribing information for Chantix regarding serious neuropsychiatric symptoms experienced in patients taking Chantix. These symptoms include changes in behavior, agitation, depressed mood, suicidal ideation, and attempted and completed suicide. While some patients may have experienced these types of symptoms and events as a result of nicotine withdrawal, some patients taking Chantix who experienced serious neuropsychiatric symptoms and events had not yet discontinued smoking. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of Chantix therapy. See the FDA Information for Healthcare Professionals Sheet for recommendations and considerations for healthcare professionals on using Chantix therapy for patients.

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