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There is some evidence that nabumetone (1000 mg once daily) in comparison with piroxicam (20 mg once daily) in patients with OA in general practice is associated with a lower incidence and less severe occurrence of stomach pain but with more withdrawals due to lack of efficacy. The aim of this analysis was to investigate whether these differences are reflected in health-related quality of life assessments. Patients (n=198) included in this study were selected in general practice according to a protocol. The patients were randomized and treated for a period of six weeks. Clinical assessments were performed by the general practitioner (GP) during treatment. The Sickness Impact Profile (SIP), the Activities of Daily Living (ADL), and a pain questionnaire were filled out by the patients before and after treatment. As measured with the SIP, the ADL and the pain questionnaire, there were no significant differences between nabumetone and piroxicam. The comelations between (changes in) patient assessments and (changes in) clinical assessments were low. The differences between the two drugs regarding withdrawals and adverse events were not reflected by patient health-related quality of life assessments. There was a low correlation between patient health-related quality of life assessment and clinical assessments. To get a complete picture of the efficacy and safety of a drug, patient health-related quality of life assessments should be a part of a clinical trial.

The influence of concurrent administration of paracetamol with indomethacin on the plasma concentrations of these drugs was studied in rats. Orally administered paracetamol reduced the plasma levels of indomethacin during the first 2 hours after oral administration. Later, 16 and 24 hours after administration of indomethacin, the plasma levels exceeded the control values due to the concurrent oral administration of paracetamol. These data suggest that paracetamol delayed the absorption of indomethacin. In contrast the plasma concentrations of paracetamol were not influenced substantially by indomethacin. When paracetamol was co-administered subcutaneously with oral indomethacin, the plasma levels of the latter drug were not influenced. It is concluded that the protective effect of paracetamol against the gastric injuring side effect of indomethacin, which also occurs with subcutaneous administration of paracetamol, cannot be solely due to lowered plasma concentrations of indomethacin.

Objective: Investigation of the current application of direct-to-consumer (DTC) communication on prescription only medicines via the Internet in the Netherlands. Method: Questionnaires were sent by e-mail to 43 Dutch innovative pharmaceutical industries and 130 Patient Association and Support Groups (PASGs). Results: In this pilot study, the response of the pharmaceutical industry was rather low but the impression is that they were willing to invest in DTC communication. The majority of the websites of PASGs did not link to websites of pharmaceutical companies. The PASGs had no opinion whether patients can make a good distinction between DTC advertising and information on websites of the pharmaceutical industry nor about the quality. PASGs did not think unambiguously about the impact on the patient–doctor relationship. Conclusion: The impact of DTC communication on prescription only medicines via the internet is not yet clear in the Netherlands.

A pharmacokinetic study after a single dose of ceftriaxone, cefoxitin, cefuroxime and ceftazidime was performed to investigate the influence of protein binding and severity of disease on the renal elimination. In intensive-care patients drug-protein binding was substantially less compared to that in volunteers and patients with less complicated diseases. This did not result in increased elimination but, due to increased apparent volumes of distribution, prolonged half-life times were observed. Consequently, in patients with complicated disease states a dosage regimen should be based on pharmacokinetic studies performed in a similar patient group.

The conformational change of albumin which occurs around physiological pH, the so-called N-B transition, has been studied by measuring the induced circular dichroic signal of the oxyphenbutazone-albumin complex. This N-B transition has been characterized by a set of parameters according to the two-state model of Monod, Wyman and Changeux. The influence of calcium ions on the N-B transition has been interpreted in terms of a change in some of the parameters describing the two-state model,viz. a decrease of the apparent pK value of the histidines and of the apparent allosteric constant of the oxyphenbutazone-albumin complex. This apparent pK change increases with increasing Ca2+ concentration, whereas the apparent allosteric constant approaches a final value at 5 mM Ca2+. From acid-base titration curves of albumin in the presence and in the absence of Ca2+ it could be concluded that in the presence of Ca2+ less histidines are titratable than in the absence of Ca2+. Assuming that these histidines are not involved in the N-B transition it follows that at least four to five histidines are involved in the N-B transition.