e/c NSAIDS

[johnep]

MSD produced indocid in a coated tablet with a minute hole produced by laser. However, high local concentration if hole against stomach wall caused severe problems and product was dropped.
johnep

[Pharmanaut]

Originally Posted by johnep

MSD produced indocid in a coated tablet with a minute hole produced by laser. However, high local concentration if hole against stomach wall caused severe problems and product was dropped.
johnep

I remember that - it was called Osmosin.

There might be two things at work with the NSAIDs, the direct effect and the systemic effect. The direct effect might be caused by a 'lump' of the drug being in one place in the stomach acting on the mucosa, whereas the systemic effect involves more even drug distribution. A lot of them are propionic acid derivatives, so the high pH of the stomach would make them less dissociated and relatively more able to pass through the stomach wall. Or something like that science stuff kind of thing...I suppose, maybe possibly.

[_Rob_]

Ah, good ol' EC aspirin/NSAIDs debate....

Well, there was some interesting research on this on so long ago which looked at incidence of GI irritation in plain vs EC aspirin. They did find that the patients on EC aspirin had a lower rate of GI related problems. Interestingly, the reasons they stated for this was a reduced bioavailability of EC aspirin. As somebody quite rightly pointed out earlier, NSAID GI irritation is cause by a systemic COX inhibition decreasing prostaglandin production and hence reduced gastric protection. That said, I feel sure remembering from my uni days, that aspirin (acetylsalicylic acid) crystals are ‘needle like’ (if looked at under an electron microscope) and have been blamed for making *very* small lacerations to the stomach lining.

In my hospital we swap everybody to plain aspirin – it’s a money thing!

[Zoggite]

Originally Posted by _Rob_

In my hospital we swap everybody to plain aspirin – it’s a money thing!

That's fine, until the whole saving gets negated by the patient being p'bed omeprazole to protect his stomach...

[Cathedral]

About this diclofenac supp. - we've got a patient with horrible ulceration in anus area after very long use of these suppositories. And of course she had them prescribed because of "weak stomach".

[johnep]

Plain 75mg aspirin 'Angettes' are very much more expensive than dispersible.
johnep

[admin]

Originally Posted by Cathedral

About this diclofenac supp. - we've got a patient with horrible ulceration in anus area after very long use of these suppositories. And of course she had them prescribed because of "weak stomach".

Hell, what a choice to have to make!

Seriously, when I worked in industry my boss would sign up for any healthy person volunteer trials that were being done in the company. He did one, where he had an endoscope put up his bum, photographs were taken, and then he used NSAID suppositories for a specified time. After the time, he had the endoscope and photos done again to see if there were any changes!

I was personally never hard up enough to take part in any - thank God!

[Zoggite]

Originally Posted by Cathedral

About this diclofenac supp. - we've got a patient with horrible ulceration in anus area after very long use of these suppositories. And of course she had them prescribed because of "weak stomach".

Just out of sheer scientific correctness, I feel I need to mention that one of the PMR-systems (that's Patient Medication Records) that we used to have, used to put the following caution on all labels for suppositories: "remove wrapper first"...
Could this be the cause of the anal ulceration?

[Cathedral]

Hehe, Zoggite - it unfortunately could possibly be
I live in a region which used to be the poorest in the EU, but it isn't now. Simply because Romania and Bulgaria joined... And people are not very well educated here I'm afraid. At least most of them.

What I wanted to mention too is enormous (simply hard to explain) use of ketoprofen 100mg here. They take it twice a day for months (!). Later they simply take it with ranitidine (cheaper) or with omeprazol (if they have the money) :/

What I wanted to ask is if you still have some preparations of butapirazol and indometacin?

[Jeff]

Originally Posted by Cathedral

What I wanted to ask is if you still have some preparations of butapirazol and indometacin?

butapirazol = phenylbutazone - was banned for human used several years ago.
indometacin - still being used.


Jeff