Why I like Warfarin and Why You Should too

I am aware the love for Novel Oral Anticoagulants (NOACs) is growing and that warfarin is falling out of favour, especially in the setting of stroke prevention in atrial fibrillation or in the management of venous thromboembolism.  But hear me out on this one. Warfarin should stay and here’s why.

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Navigating Treatment Options for Venous Thromboembolism (VTE) Disease

A patient was presented at the ER with an unprovoked deep vein thrombosis (DVT). It  was eventually assessed to require indefinite oral anticoagulation therapy. He was started on rivaroxaban, a NOAC (novel oral anticoagulant).  Rivaroxaban as well as other NOACs  are recommended in the latest Chest guidelines as first line treatment options for venous thromboembolism disease. But the provincial drug plan does not recognize this update yet and is set up such that warfarin is the preferred agent for long term anticoagulation therapy. NOACs would only be reimbursed for the initial 6 months if treating conditions such as DVT.

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Nabilone Shortage or a Fabricated Reason for Medical Cannibis?

I recently blogged about the drug shortage of Nabilone which I thought has resolved. So when I heard patients having difficulty with getting the medication again, I picked up the phone and started calling.

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Why new drugs are not sexy yet?

When a new medication is available, there is often a lot of excitement and hype about how a new option may bring hope to a medical condition. The new medication may offer breakthrough in improving important clinical outcomes (e.g. improving survival, preventing disease complications and significantly offering better quality of life for patients).  But before we jump on the bandwagon to start prescribing a new medication, here are few considerations the sales rep may not be quick to highlight or share.

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No! Taking two Basal Insulins is not OK.

Insulin is considered a high risk medication for which serious adverse events can occur if an incorrect dose is inadvertently given. That is why we have implemented double check systems at many points of care or processes in hope to minimize and prevent these potentially serious and fatal errors.

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Lesser of the two evils: Domperidone or Metoclopramide?

I am often intrigued to connect with clinicians who have various opinions on medications.  In particular to GI motility agents, we often discuss the safety profile of domperidone vs. metoclopramide.  They are both dopamine antagonists; one main difference is that domperidone works peripherally whereas metoclopramide can cross blood brain barriers and exert some central system effects.  The other difference is that domperidone is not commercially available in United States but only via a special access mechanism. As such, there may be more documented clinical evidence and experience with metoclopramide than with domperidone.

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