PDF DIS News - University Of Montana

DIS News

College of Health Professions and Biomedical Sciences Drug Information Service

Zinc--A Common Element for the Common Cold

Zinc is often used to treat the common cold. However, the antiviral effects of zinc are not fully understood. Zinc ions block rhinovirus from binding to the intracellular adhesion molecule-1 (ICAM-1) in vitro preventing viral replication.1 In addition, zinc has immune system-bolstering effects; however, this is not how zinc helps treat the common cold.2

On average, zinc supplementation resolves cold symptoms in about 4 days sooner than placebo.1 Decreased duration and severity of cold symptoms with zinc treatment are supported in multiple meta-analyses.1-3 However, prophylaxis with zinc for colds is not recommended because prolonged use of high-dose zinc decreases immune function and increases the risk of adverse effects.2

More studies support the use of zinc as treatment of the common cold than refute its use.1-3 Negative trial results may be due to reduction of zinc's efficacy from the binding of zinc ions by flavoring excipients.1-3 In addition, many of the studies are in small populations of subjects. Other limitations of zinc studies include variations in dosing among products, lack of blinding due to the unpalatability of zinc, and lack of documentation of rhinovirus infection.1-4

Zinc has a bad taste, and flavoring is sometimes added to increase palatability.2 However, zinc products with added flavoring have varying amounts of zinc ions available to producing antiviral effects.2,4 The use of flavoring excipients may bind zinc ions and prevent ion release, leading to lower absorption of zinc and decreased efficacy. Zinc ion release is almost completely inhibited when zinc gluconate is combined with citric acid, sorbitol, and mannitol, but glycerine in zinc gluconate lozenges does not affect the flow of free zinc ions.2,4

Zinc Lozenges (9 to 24 mg zinc/lozenge):2

Take 1 lozenge every 2 hours while awake starting at symptom onset.

Efficacious if taken within the first 24-48 hours of symptom onset; however, better results are seen with early administration.

Use the same dosing frequency for 7-10 days (max of 14 days) or until 6 hours after cold symptom resolution.

Adverse effects: metallic taste, nausea, vomiting, diarrhea, mouth sores

Recommended formulations: Zinc gluconate + glycerine2,4

Zinc acetate + glycerol monosterate+ stevia + peppermint oil3

Nasal Gel Spray:

No longer recommended5 --In 2009,

the FDA informed patients to discontinue Zicam? (zinc-containing) nasal spray and swabs after more than 130 patients reported permanent loss of smell.

Regardless of the brand, zinc-containing nasal sprays are not recommended.

Adverse effects: permanent anosmia, nasal and throat irritation, headache, bad taste, bloody or dry nose2

**CAUTION: Ingesting too much zinc may decrease copper absorption and result in anemia**

Zinc appears to be safe at recommended doses during pregnancy and when breastfeeding. High doses in the third trimester of pregnancy can cause premature births and stillbirths.2

Zinc may interact with many drugs.2 Thiazide diuretics can increase excretion of zinc. Chemotherapeutic agents may be less effective when the patient is taking zinc supplements since zinc may increase production of tumor cells. Some antibiotics can chelate zinc, so administration of antibiotics should be at least 2 hours before or 4-6 hours after zinc administra-

Continued on Page 5

February 2015

Volume 19, Issue 2

Inside this issue:

PlegridyTM

2

(peginterferon

beta-1a)

Epanova? (omega- 3 3 carboxylic acids)

Patient Information: Gluten and Gluten- 4 Free Diets

Patient Information: 6 Natural Cold & Flu Remedies

Patient Information: 7 The Winter Blues

We welcome any comments and suggestions for future newsletter topics.

Editors in Chief: Sherrill Brown, DVM, Pharm.D, BCPS

Christina Buchman, PharmD

PlegridyTM (peginterferon beta-1a)--New Option for Multiple Sclerosis

PlegridyTM (peginterferon beta-1a) is the first pegylated interferon for patients with relapsing multiple sclerosis and has a longer half-life and duration of action than interferon.1-3 Because the dosing interval of peginterferon beta-1a is less frequent than interferson beta-1a (every 2 weeks vs. every week), peginterferon beta-1a may be preferred by patients.2,4

Peginterferon beta-1a was more effective than placebo in treating patients with relapsing multiple sclerosis.5 In this 48-week, randomized, double-blind study, 1512 patients with relapsing-remitting multiple sclerosis received either placebo, peginteferon beta-1a 125 mcg every 2 weeks, or peginteferon beta-1a 125 mcg every 4 weeks. Patients on peginterferon beta-1a had significantly lower annualized relapse rates than those on placebo (Q2weeks 0.206, Q4weeks 0.397, placebo 0.397). Compared to patients taking placebo, fewer patients taking peginterferon beta-1a experienced worsening of their disabilities (6.8%, 6.8%, 10.5%, respectively). Also, peginterferon beta-1a treatment delayed the time to first relapse when compared to placebo.5

more than 10% of patients included my- By Yawen Deng, PharmD Candidate

algia (19%), chills (17%), injection site

pain (15%), weakness (13%), and pruri- REFERENCES:

tus at the injection site (13%).1,5

1. Plegridy [package insert]. Cam-

Peginterferon beta-1a should be used

bridge, MA: Biogen Idec Inc.;2014

with caution in some patients.1 Peginter-

August.

feron beta-1a should be used cautiously in patients with hepatic impairment be-

2.

cause production of hepatic enzymes

may be increased and hepatic diseases

may develop. Patients at risk for depres-

sion and suicide may need to discontinue

Annibali V, Mechelli R, Romano S, et al. IFN- and multiple sclerosis: from etiology to therapy and back. Cytokine Growth Factor Rev 2014;pii:S1359-6101(14)00138-5.

treatment with peginterferon beta-1a if 3. these symptoms develop. Patients with a

history of seizures should be cautioned

about the possible increase in seizure risk with peginterferon beta-1a.1

Plegridy (n.d.). Biogen Idec Web site. Available at: http:// therapies_plegridy.aspx?ID=20546. Accessed December 7, 2014.

Peginterferon beta-1a is available as pen 4. or prefilled syringe with needle.1 The pens and syringes are color-coded for each strength (63 mcg, 94 mcg, and 125 5. mcg). The dose of peginterferon beta-1a is titrated from 63 mcg on day 1 to the maintenance dose of 125 mcg every 2 weeks using the following schedule (see image below):1

Lexi-Comp, Inc. (Lexi-DrugsTM ). Lexi-Comp, Inc.; December 8, 2014.

Calabresi PA, Kieseier BC, Arnold DL, et al. Pegylated interferon beta1a for relapsing-remitting multiple sclerosis (ADVANCE): a randomised, phase 3, double-blind study. Lancet Neurol 2014;13(7):657-665.

Over 80% of the participants were Cauca- Day 1: Inject 63 mcg subcutaneous-

sian, so the results of this study might not apply to other ethnic groups.5 Another limi-

ly. **orange pen or the syringe

tation was that the study lasted only 48

Day 15: Inject 94 mcg subcutane-

weeks, so the long-term efficacy of peginter-

ously. **blue pen or the syringe

feron beta-1a in reducing multiple sclerosis

cannot be elucidated.5

Day 29 and after: Inject 125 mcg

subcutaneously every 2 weeks.

Injection site redness (62%), influenza-like

**grey pen or the syringe

illness (47%), fever (45%), and headache

(44%) were the most common adverse ef-

fects reported with peginterferon beta-1a use.1,5 Other adverse effects reported by

Injection sites should be rotated to de-

crease reactions at the injection site, including injection site necrosis.1

Image: Volume 19, Issue 2

Page 2

Epanova? (omega-3 carboxylic acids) for Severe Hypertriglyceridemia

Epanova? is a new medication for the

In the EVOLVE trial, GI symptoms were 2. US FDA approves Epanova for

treatment of severe hypertriglyceridemia the most common side effects and in-

the treatment of adults with severe

with triglyceride levels greater than 500 mg/dL. Epanova? should be used as an adjunct to a triglyceride-lowering diet.1 Epanova? is the first prescription prod-

cluded diarrhea, nausea, vomiting, eructation, and upper abdominal pain.3 Seri-

ous side effects in the trial included an

increase in LDL levels by 19% in both

hypertriglyceridemia (5/6/2014). AstraZeneca Web site. Available at: Media/ Press-releases/

uct containing omega-3 as the free fatty the 2 g/day and the 4 g/day groups com-

Article/2014056--us-fda-approves-

acid forms of eicosapentaenoic ac-

pared to a 3% increase in LDL levels in

epanova-for-the-treatment-adults-

id (EPA) and docosahexaenoic acid (DHA).2,3 The free fatty acid form has

the olive oil group. Discontinuation due to adverse events ranged from 5 to 7% of

severe-hypertriglyceridaemia. Accessed November 6, 2014.

increased levels of EPA and DHA compared to ethyl ester formulations.4 This gives Epanova? superior bioavailability

compared to other formulations because

the free fatty acids form is absorbed in

the digestive tract without requiring a high fat meal for this absorption.4,5 The exact mechanism of action of Epanova? is unknown; however, Epanova? may

potentially decrease the synthesis of triglycerides in the liver.1

participants in all three dosage groups of

Epanova?.3

3. Kastelein JP, Maki KC, Susekov

The recommended doses of Epanova?

A, et al. Omega-3 free fatty acids for the treatment of severe hyper-

are either 2 capsules once daily or 4 cap-

triglyceridemia the Epanova for

sules once daily depending on the pa-

lowering very high triglycerides

tient's response to the medication.1 Each 1 g capsule of Epanova? contains a total

(EVOLVE) trial. J Clin Lipidol 2014;8:94-106.

4. FDA approves Epanova, a different form of omega-3 (5/16/2014). Diabetes in Control Web site.

Epanova? reduced triglyceride levels in a twelve-week, phase III, randomized, double-blind study (EVOLVE).3 Trial participants had triglyceride levels >500 mg/dL but 20 kg/m2, were willing to follow the Therapeutics Lifestyle Changes (TLC) diet, and limited their fish intake to less than twice weekly during the trial. With the exception of

5. Epanova?(n.d.). Omthera Pharma-

ceuticals Web site. Available at:

. com/

concentration of 15-25% DHA and 5060% EPA.5 The capsules should be swal-

epanova_overview.html. Accessed November 13, 2014.

statins and ezetimibe, lipid-lowering

lowed whole and can be taken with or

medications were not allowed during the without food. Epanova? should be used

study. There were 4 study groups: olive oil 4 g/day (control; n=99), Epanova? 2 g/day (n=100), Epanova? 3 g/day

(n=101), and Epanova? 4 g/day (n=99).3

in conjunction with a triglyceridelowering diet.1

Epanova? is a new option for treating severe hypertriglyceridemia.1-3 Patients

All 3 Epanova? groups had greater re- should be monitored for increases in ductions in triglyceride levels compared LDL levels while on Epanova?, but both

to the olive oil group (p ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download