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.
Something exciting seems to be gaining momentum – that the talk of a National Pharmacare may actually transpire into a reality. Eric Hoskins, our former provincial health minister in Ontario, has taken on a new role to chair a Federal Government Advisory Council for a National Pharmacare Plan.
Health Canada has established a Special Access Programme (SAP) for physicians to apply for access to unlicensed medicines. The premise of the program is to allow for compassionate release of unlicensed products in special circumstances, usually for emergency release in serious or life threatening conditions where convention treatments have failed, unsuitable or unavailable. While the program is well intentioned, there are limitations and considerations if one decides to follow this route of access.
After the introduction of denosumab few years ago, another monoclonal antibody is making its way in the market for osteoporosis treatment – romosozumab. While denosumab is a RANKL inhibitor which inhibits osteoclast activity and bone resorption, romosozumab targets and inhibits sclerotin, thereby increasing the osteoblast activities and bone formation. The ARCH study was recently published in the New England Journal of Medicine; this study has highlighted both the benefits of romosozumab in the treatment of osteoporosis as well as its potential safety concerns in cardiovascular health.
Patients are often concerned about the potential side effects of a medication. At the pharmacy, we may affix various ancillary labels on the prescription vials. But those labels have been around for a long time. It is time to upgrade them to be something easy to comprehend. I also need your help! I am looking for your votes on whether the following icons illustrate the side effects as described. Help me out by participating in the poll.
Often we hear from the press or the media that a medication has a black box warning. So what does it mean for the prescriber, or the patient? After all, it does sound very intimidating to have a “Black Box Warning” for a medication that a clinician has to prescribe, or a patient who has been asked to take.
ISMP Canada has developed the 5 questions that each patient should ask about medications? Of the 5 questions, I find that proper use is one that tends to be most difficult to communicate clearly and succinctly. How to take your medication? Do you take it with food? Without food? What does it mean to take it on an empty stomach? Can you take it with dairy products? Or mix with supplements and alcohol?