Drug and Alcohol Rehabilitation: Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal.

Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.

Filed under: Drug and Alcohol Rehabilitation

Ann Intern Med. 2013 Jan 1; 158(1): 1-9
Coffin PO, Sullivan SD

Chinese translationOpioid overdose is a leading cause of accidental death in the United States.To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses.Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society.Published literature calibrated to epidemiologic data.Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses.Lifetime.Societal.Naloxone distribution for lay administration.Overdose deaths prevented and incremental cost-effectiveness ratio (ICER).In the probabilistic analysis, 6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed (95% CI, 71 to 716). Naloxone distribution increased costs by $ 53 (CI, $ 3 to $ 156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an ICER of $ 438 (CI, $ 48 to $ 1706).Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses, and it was cost-saving if it resulted in fewer overdoses or emergency medical service activations. In a “worst-case scenario” where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $ 14 000. If national drug-related expenditures were applied to heroin users, the ICER was $ 2429.Limited sources of controlled data resulted in wide CIs.Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.National Institute of Allergy and Infectious Diseases.
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Recent Developments in Sterol 14-demethylase Inhibitors for Chagas Disease.

Filed under: Drug and Alcohol Rehabilitation

Int J Parasitol Drugs Drug Resist. 2012 Dec; 2: 236-242
Buckner FS, Urbina JA

The protozoan parasite, Trypanosoma cruzi, causes the most prevalent parasitic infection in the American continent. It gives rise to life-long infection in humans and results in severe cardiomyopathy or other life-threatening manifestations (Chagas disease) in ~30% of those infected. Animal models and clinical studies indicate that etiological treatment of the infection reduces the risk of developing the disease manifestations. Unfortunately, the existing chemotherapeutics have suboptimal antiparasitic activity and cause significant side effects in many patients, thus better anti-trypanosomal drugs are greatly needed. The sterol biosynthesis pathway has received attention as a target for the development of new drugs for Chagas disease. In particular, inhibitors of sterol 14-demethylase (CYP51) are shown to be extremely active on Trypanosoma cruzi in vitro and in animal models. Antifungal drugs (i.e. azoles) in clinical use or in clinical studies have been extensively tested preclinically on Trypanosoma cruzi with posaconazole and ravuconazole demonstrating the most promising activity. As a result, posaconazole and a pro-drug of ravuconazole (E1224) are currently being evaluated in Phase II studies for Chagas disease. Additional CYP51 inhibitors that are specifically optimized for anti-Trypanosoma cruzi activity are in development by academia. These represent an alternative to proprietary antifungal drugs if the latter fall short in clinical trials or are too expensive for widespread clinical use in disease endemic countries. The research over the next few years will help define the role of CYP51 inhibitors, alone or in combination with other drugs, for managing patients with Chagas disease.
HubMed – drug


Clinical features of immediate hypersensitivity to isopropylantipyrine.

Filed under: Drug and Alcohol Rehabilitation

Allergy Asthma Immunol Res. 2013 Jan; 5(1): 55-8
Hwang EK, Nam YH, Jin HJ, Shin YS, Ye YM, Park HS

Hypersensitivities induced by isopropylantipyrine (IPA), a pyrazolone derivative within the wider family of non-steroidal anti-inflammatory drugs (NSAIDs), are rarely reported. We characterized the clinical features of 12 patients with IPA-induced hypersensitivity. Twelve patients with immediate hypersensitivity to IPA were enrolled and classified into two groups: group I, consisting of eight patients (66.7%) with selective hypersensitivity; and group II, consisting of four patients (33.3%) showing cross-intolerance to other NSAIDs. Skin prick and intradermal and oral provocation tests with IPA were performed. To confirm selective hypersensitivity, an aspirin oral provocation test was also conducted. The most common manifestations were cutaneous reactions (91.7%), followed by anaphylaxis (66.7%), respiratory (41.7%), ocular (16.7%), and gastrointestinal reactions (16.7%). The median age and the median age at onset were 34.5 (range, 23-55) years and 28.0 (range, 7-47) years, respectively. In both groups I and II, all patients showed negative responses to skin prick testing, whereas only two patients in group I were positive in response to intradermal IPA tests. The response time after drug exposure was shorter in group I than in group II. Here, we report on two types of IPA hypersensitivity: selective and cross-intolerant NSAID hypersensitivity. An immediate IgE-mediated reaction may be involved in patients with selective hypersensitivity, whereas a cyclooxygenase-1-related inhibition mechanism may be a responsible mechanism for the patients with cross-intolerance to multiple NSAIDs.
HubMed – drug


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