Data from the PRACTICAL study showed that budesonide-formoterol reliever therapy in a single inhaler for patients with mild to moderate asthma was associated with a 31% reduction in the risk for severe exacerbations, as compared with maintenance budesonide plus terbutaline reliever therapy.wisepoqder Formoterol powder

“The budesonide-formoterol reliever regimen in mild to moderate asthma is based on the proven efficacy of the budesonide-formoterol maintenance and reliever regimen in moderate to severe asthma,” Richard Beasley, DSc, from the Medical Research Institute of New Zealand and the Capital and Coast District Health Board, wrote in an email to Healio Pulmonology. “This regimen has the potential to overcome the problem of underuse of inhaled steroids in asthma by using the reliever as its vehicle for administration.”
Investigators conducted the open-label, parallel-group, superiority trial at 15 primary care or hospital-based clinical trial units and primary care practices in New Zealand. They randomly assigned 890 adults aged 18 to 75 years with asthma to reliever therapy with one inhalation of budesonide 200 g–formoterol 6 g (Symbicort Turbuhaler, AstraZeneca) as needed or maintenance budesonide 200 g (Pulmicort Turbuhaler, AstraZeneca) twice daily plus two inhalations of terbutaline 250 g (Bricanyl Turbuhaler, AstraZeneca; not available in the U.S.) as needed.

All patients were using short-acting beta-agonists for symptom relief with or without maintenance low to moderate doses of inhaled corticosteroids during the previous 12 weeks. The study included six visits over 52 weeks and the primary outcome was the number of severe exacerbations per patient per year.

Fewer exacerbations

The final analysis included 885 patients. Results showed that the rate of severe asthma exacerbations was lower in the as-needed budesonide-formoterol group than in the maintenance budesonide plus as-needed terbutaline group (relative rate = 0.69; 95% CI, 0.48-1), as was the rate of combined moderate and severe asthma exacerbations (relative rate = 0.7; 95% CI, 0.51-0.95). Both time to first severe exacerbation and time to first moderate or severe exacerbation were longer with budesonide-formoterol vs. maintenance budesonide plus as-needed terbutaline, the researchers noted.

The most common adverse event in both treatment groups was nasopharyngitis, occurring in 35% of patients receiving as-needed budesonide-formoterol and 32% of those receiving maintenance budesonide plus as-needed terbutaline.

“This is the first independent study showing that budesonide-formoterol reliever therapy outperforms maintenance inhaled corticosteroid and [short-acting beta-agonist (SABA)] reliever therapy in mild to moderate asthma in reducing severe exacerbation risk,” Beasley said. “Taken together with the three earlier studies of budesonide-formoterol reliever therapy in mild asthma published in The New England Journal of Medicine, and the studies of the budesonide-formoterol maintenance and reliever regimen in moderate to severe asthma, there is now strong evidence that budesonide-formoterol outperforms SABA therapy across the spectrum of asthma severity.”

Edecrin (ethacrynic acid) is a loop diuretic (water pill) used to treat fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. Common side effects of Edecrin include:wisepoqder Ethacrynic acid

Using too much Edecrin can lead to serious water and mineral loss (dehydration). Tell your doctor if you have unlikely but serious symptoms of dehydration including loss of appetite, confusion, severe dizziness, fainting, unusual dry mouth, thirst, severe headache, fast or irregular heartbeat, muscle cramps or spasms, nausea, vomiting, numbness and tingling, seizure, decrease in amount of urine, or unusual weakness or tiredness.

The smallest dose of Edecrin should be given to produce gradual weight loss (about 1 to 2 pounds per day). Onset of diuresis usually occurs at 50 to 100 mg for adults. After diuresis has been achieved, the minimally effective dose (usually from 50 to 200 mg daily) may be given on a continuous or intermittent dosage schedule. Edecrin may interact with lithium, digoxin, blood thinners, other diuretics, steroids, cancer medicines, cephalosporin antibiotics, aspirin and other salicylates, NSAIDs (nonsteroidal anti-inflammatory drugs), amikacin, gentamicin, netilmicin, streptomycin, or tobramycin. During pregnancy, Edecrin should be used only when prescribed. It is unknown if this drug passes into breast milk. Consult your doctor before breastfeeding.

Our Edecrin (ethacrynic acid) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

ndian Pharma major Lupin Limited (Lupin) on 9 Sep 2019, announced that it has received approval for its Ethacrynic Acid Tablets USP, 25 mg, from the United States Food and Drug Administration (U.S. FDA).wisepoqder Ethacrynic acid powder

Lupin’s Ethacrynic Acid Tablets USP, 25 mg, is the generic version of Edecrin® Tablets, 25 mg, of Bausch Health Americas, Inc. It is indicated for treatment of edema when an agent with greater diuretic potential than those commonly employed is required.

Treatment of the edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome.
Short-term management of ascites due to malignancy, idiopathic edema, and lymphedema.
Short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or the nephrotic syndrome.
Intravenous ethacrynic acid sodium is indicated when a rapid onset of diuresis is desired, e.g., in acute pulmonary edema, or when gastrointestinal absorption is impaired or oral medication is not practicable.
Ethacrynic Acid Tablets USP had annual sales of approximately USD 24 million in the US (IQVIA MAT June 2019).

Lupin announced that it has received approval for its Ethacrynic Acid Tablets USP, 25 mg, from the United States Food and Drug Administration (USFDA).Lupin's Ethacrynic Acid Tablets USP, 25 mg, is the generic version of Edecrin Tablets, 25 mg, of Bausch Health Americas, Inc.Ethacrynic Acid Tablets USP (RLD: Edecrin Tablets) had annual sales of approximately USD 24 million in the US (IQVIA MAT June 2019).

Mylan has launched the first generic version of esmolol hydrochloride (Brevibloc, Baxter) in the United States for treatment of tachycardia.1 According to Mylan, Esmolol Hydrochloride in Sodium Chloride Injection, 2,500 mg/250 mL (10 mg/mL) Single-Dose Plastic Bag, and 2,000 mg/100 mL (20 mg/mL) Single-Dose Plastic Bag products are being offered to the global pharmaceutical company’s institutional customers.wisepoqder Esmolol powder

Mylan’s esmolol hydrochloride products are in the market following FDA approval of an Abbreviated New Drug Application (ANDA). Esmolol Hydrochloride in Sodium Chloride Injection is indicated for the short-term treatment of control of ventricular rate in supraventricular tachycardia, including atrial fibrillation and atrial flutter, and control of heart rate in noncompensatory sinus tachycardia, and control of perioperative tachycardia and hypertension.1

Brevibloc is contraindicated in patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock, or overt cardiac failure. The drug should also not be used for treatment of hypertension due primarily to vasoconstriction associated with hypothermia or to prevent tachycardia and/or hypertension.2 In addition, Baxter is cautioning Brevibloc users to carefully monitor during infusion for patients with LV dysfunction, CHF, hypotension, reactive airway disease, and diabetes. Generally, patients with bronchospastic disease should not receive beta blockers, according to Baxter. Due to the relative beta1 selectivity and titratability, esmolol hydrochloride may be used with caution in patients with bronchospastic disease, titrated to the lowest possible dose.2

The most common adverse effect with Brevibloc is hypotension; asymptomatic (25%) and symptomatic (12%), mainly dizziness and diaphoresis. Hypotension usually reverses within 30 minutes of decrease of dose or termination of infusion. Infusion site reactions (8%) have also been reported.2

Cyclofenil powder

wisepoqder Cyclofenil powder (INN, USAN, BAN) (brand names Fertodur, Menopax, Ondonid, Ondogyne, Sexovid, others) is a selective estrogen receptor modulator (SERM) used as a gonadotropin stimulant which is or has been marketed in Europe, South Korea, Mexico, and Brazil, among other countries.

Cyclofenil powder is a gonadal stimulant and inducer of ovulation. It is used in the treatment of infertility and amenorrhea, but is thought to be less effective than CLOMIPHENE.
05 Cyclofenil powder (2624-43-3) History

Cyclofenil powder (INN, USAN, BAN) (brand names Fertodur, Menopax, Ondonid, Ondogyne, Sexovid, others) is a selective estrogen receptor modulator (SERM) used as a gonadotropin stimulant which is or has been marketed in Europe, South Korea, Mexico, and Brazil, among other countries.

Cyclofenil was first introduced in 1970 under the brand name Ondogyne in France. Subsequently, it was introduced under the brand names Sexovid in Japan in 1972, Ondonvid in the United Kingdom in 1972, and Fertodur in West Germany in 1972 and Italy in 1974. It was also marketed as Sexovid in Sweden, Neoclym in Italy, and Klofenil in Turkey.

Cyclofenil was studied in the 1970s as an agent to induce ovulation in infertile women. It was then investigated as a possible treatment for scleroderma in the 1980s, but was found to be ineffective. Later study of its efficacy in treating Raynaud’s phenomenon in people with scleroderma also found no statistically significant benefit.
Cyclofenil powder is a nonsteroidal antiestrogen that is used in the treatment of menstrual disturbances and anovulatory infertility due to hypothalamic-pituitary insufficiency
Cyclofenil is an analytical reference standard categorized as an anti-estrogen. 1,2 Anti-estrogens, including cyclofenil, have been used as performance-enhancing drugs in sports doping. This product is intended for research and forensic applications

Atrial fibrillation (AF) is an irregular and often rapid heart rate that can increase the risk of stroke, heart failure, and other heart-related complications. Its incidence increases with age and the presence of concomitant heart disease. We present the cases of a 93-year-old woman, an 82-year-old man, and an 87-year-old woman who developed AF tachycardia. This report highlights the use of a bisoprolol transdermal patch to treat AF tachycardia in 3 adult elderly patients. In this paper, we report an initial treatment strategy using a bisoprolol transdermal patch and show heart rate trends for 24 hours.wisepoqder Bisoprolol powder

1. Introduction

Clinical atrial fibrillation (AF) is associated with increased rates of stroke, heart failure, mortality, hospitalization, and cognitive decline, much of which may present suddenly and constitute irretrievable harm [1, 2]. AF symptoms often include heart palpitations, shortness of breath, and weakness. Rate control is possible in the majority of patients with AF. Beta- (β-) blockers have been the most effective drugs [3]. However, swallowing tablets or capsules is sometimes difficult for elderly people because of dysphagia [4]. Moreover, aspiration pneumonia can be associated with dysphagia [5]. Bisoprolol is also available as a transdermal patch in Japan. Medication adherence is better with the use of a transdermal patch than with the use of tablets, particularly in elderly patients who might have difficulty with oral administration. In this paper, we report an initial treatment strategy for AF tachycardia using a bisoprolol transdermal patch in elderly patients.

2. Case Presentation

This 93-year-old woman, a resident of a special elderly care nursing home, was referred to our hospital for the treatment of cellulitis. She related a history of treatment for hypertension and atrial fibrillation (AF). Upon arrival, her blood pressure (BP) was 119/83 mmHg and heart rate (HR) was 82 bpm. An electrocardiogram (ECG) demonstrated AF and a complete right bundle branch block (Figure 1(a)). During the treatment for cellulitis using antibiotics, she complained of dyspnea. Her HR increased to 140 bpm and her chest X-ray (CXR) showed pulmonary edema and congestion (Figure 1(b)). Echocardiography demonstrated preserved cardiac contractility with an ejection fraction (EF) of 60%, indicating heart failure with a preserved EF. She was administered furosemide (20 mg/day) to treat heart failure. In addition, a bisoprolol transdermal patch (2 mg) was applied to her chest. Her HR trends were significantly decreased within 8 hours and the control of HR continued for 24 hours (Figure 2). Eventually, her CXR and symptoms improved.
An 82-year-old man was admitted to our hospital for the treatment of ileus. He related a history of treatment for persistent AF and hypertension. He was administered bisoprolol fumarate tablets (2.5 mg/day) for AF before admission. His HR on admission was 87 bpm. However, he could not take oral medicine because of fasting for treatment of ileus. After 3 days of fasting, he developed AF tachycardia and his HR increased to 150 bpm. Bisoprolol transdermal patch (4 mg) was applied to his chest. This dose was equal to a 2.5 mg bisoprolol fumarate tablet. His HR trends were significantly decreased after 8 hours of bisoprolol transdermal patch, and the frequency and duration of AF decreased until 24 hours after administration (Figure 3).

Upsher-Smith Laboratories, LLC (Upsher-Smith) today announced that it has received U.S. Food and Drug Administration (FDA) approval of its abbreviated new drug application (ANDA) for Bumetanide Tablets, USP, 0.5 mg, 1 mg, and 2 mg. Bumetanide Tablets are a generic version of the brand product, Bumex (bumetanide) Tablets.* wisepoqder Bumetanide

The bumetanide tablet market had U.S. sales of approximately $84.5 million for the 12 months ending November, 2017 according to IMS Health."Last year was an exciting one for Upsher-Smith," said Rusty Field, President and CEO of Upsher-Smith. "We were part of one of the largest pharmaceutical transactions of the year and continued to expand our generic product portfolio. We are pleased to begin this year by adding Bumetanide Tablets to our portfolio of quality generic products."

Upsher-Smith Laboratories, LLC is a trusted U.S. pharmaceutical company that has strived to deliver quality, affordable generic medications for nearly a century. In June 2017, Upsher-Smith was acquired by Sawai Pharmaceutical Co., Ltd., a large publicly traded generics company in Japan that had been seeking entry into the U.S. market. Upsher-Smith and Sawai share a strikingly similar family history and hold many of the same cherished goals and values— most importantly, the philosophy of always putting patients first. Upsher-Smith will continue to do those things it does best, which is provide a consistent supply of quality, affordable medications and invest in its historically strong industry relationships. Ultimately, Upsher-Smith believes the acquisition by Sawai represents a tremendous opportunity to leverage each company for growth worldwide and embark together on an exciting new chapter in generics.

Bumetanide belongs to a group of medicines called loop diuretics or "water pills." Bumetanide is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. It works by acting on the kidneys to increase the flow of urine .
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For bumetanide, the following should be considered:wisepoqder Bumetanide powder

Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to bumetanide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of bumetanide in the pediatric population. Safety and efficacy have not been established .

Geriatric
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of bumetanide in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving bumetanide .There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking bumetanide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using bumetanide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.Using bumetanide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using bumetanide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.