Pharmaceutical Care and Pharmacoeconomics

What happens before diabetes comes in?

It is estimated that in 2025 as much as 10% of the population in western countries could suffer from diabetes. Pharmacists can play a role in the caring process for diabetes patients but their interventions and assistance can lower the HbA1c with only 0.5%, without reporting upon hard outcomes as amputations, ocular disturbance, renal suffering, stroke and myocardial infarction.
Preventing diabetes may pay off and the pharmacist can certainly contribute to sensitizing campaigns and encouraging programs to keep patients at risk away from diabetes. Pharmacists can also use their medicines database to study possible hints for endocrinological changes during the prediabetic phase. Pilot studies point to marked differences of use of certain medicines. Those differences can help to study endocrinological changes occurring during the prediabetic state.

Gert.laekeman@pharm.kuleuven.ac.be

Pharmaceutical Care and Pharmacoeconomics

NSAIDS: uncertainty rules the waves

There is a marked increase in the use of Non Steroidal Inflammatory Drugs (NSAIDs) after the age of 65. The drugs could only be developed after the discovery of the mechanism of action of Aspirin°. Unfortunately it was very soon discovered that the mechanism of action of these potentially useful medicines was linked to serious gastro-intestinal adverse events.
This fact led to the development of the cox-2 selective inhibitors or coxibs. From the very beginning these coxibs were critically observed, more particularly as their side effects are concerned. Rofecoxib was taken from the market due to cardiovascular complications (cf. VIGOR and APPROVE study). Also celecoxib became a suspect after long term clinical studies to prevent adiposis and Alzheimer (cf. ADAPT and APC studies). When debating whether or not to remove coxibs from the market, also conventional NSAIDs were blamed for their cardiovascular risk pattern. Frequency of use is an important variable, as according to some sources also acetaminophen could enhance cardiovascular events when daily used.

Gert.laekeman@pharm.kuleuven.ac.be

Pharmaceutical Care and Pharmacoeconomics

It is good, it is natural: towards a European market for herbal medicinal products

There is yearly increase of 5 to 7% of herbal products marketed in Europe. But innovation is scarce, as most of the plants used rely upon a long standing tradition. This traditional use can lead to complications when registration of medicinal plants as medicines is considered. There are major differences in regulatory approach between European countries.
In order to facilitate the making of a European market, the Herbal Medicinal Product Commission (HMPC) was founded as one of the regulatory bodies within the European Medicines Evaluation Agency (EMEA). There are huge differences between plant species with regard to traditional or well established use. An overwhelming amount of clinical studies is available for St.-Johnswort (Hypericum perforatum), used as an antidepressant. Quite a lot of discussion is going on about purple coneflower (Echinacea purpurea) for treating and preventing common cold. Thyme (Thymus vulgaris) has been known for centuries for its use in cough, but there hardly exists any clinical evidence when therapeutic outcomes are considered.
Quality and safety issues emerge as being even more important than clinical efficacy, making of medicinal plants an ideal subject for integrated pharmaceutical sciences.

Gert.laekeman@pharm.kuleuven.ac.be