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To expand drug abuse treatment programmes and promote sterile injection equipment, the constraining of sex education and condom availability in schools, and the failure to support adequately HIV prevention in correctional settings in an unsqueamish manner. The report suggests that unfortunately public policies at present often `run counter to the scientific evidence regarding the effectiveness' of interventions focused upon these themes. Although the authors state that they have `observed ample evidence of the lack of federal leadership in HIV prevention, [they] do not focus on this issue in this report'. Yet `this issue' screams out from every page. For the report reiterates much of the sentiment and several of the recommendations of previous reports from the Institute of Medicine. It is difficult, therefore, to believe that this report will not fall on deaf ears in the higher echelons of the federal administration. After all, the current political administration appears to embrace more wholeheartedly than ever values that run counter to rational policy making in HIV prevention. Richard Coker, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, UK.
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Table 4 Price Changes for the Top 50 Common Brand Drugs 2001-2002 Ranked by Number of Prescriptions Unit Price On 12 31 2001 Unit Price On 12 31 2002 Percent Change 13.5% 9.4% 11.7% 0.0% 3.0% 10.6% 12.7% 0.0% 4.2% 11.0% 5.0% # of Price Changes Between 12 31 2001 and 12 31 2002 LIPITOR 10MG LIPITOR 20MG PREVACID 30MG ORTHO TRI-CYCLEN ZITHROMAX 250MG PRILOSEC 20MG CELEBREX 200MG ZYRTEC 10MG PREMARIN 0.625MG CLARITIN 10MG FOSAMAX 70MG VIOXX 25MG ALLEGRA 180MG PREMPRO 0.625-2.5 MG ALBUTEROL 90MCG NORVASC 5MG NEXIUM 40MG FLONASE 50MCG ZOLOFT 100MG CELEXA 20MG TOPROL XL 50MG PAXIL 20MG WELLBUTRIN SR 150MG ZOLOFT 50MG NORVASC 10MG LIPITOR 40MG GLUCOPHAGE XR 500MG PRAVACHOL 40MG PROTONIX 40MG SYNTHROID 100MCG NASONEX 50MCG PRAVACHOL 20MG LEVAQUIN 500MG CLARINEX 5MG TOPROL XL 100MG ALLEGRA-D 120-60MG CELEXA 40MG CIPRO 500MG DIFLUCAN 150MG FLOMAX 0.4MG EFFEXOR XR 75MG ZESTRIL 10MG ALLEGRA 60MG CLARITIN-D 24 HOUR 240-10MG AUGMENTIN 875-125MG ACCUPRIL 20MG TRICOR 160MG SINGULAIR 10MG PREMARIN 1.25MG SYNTHROID 75MCG.
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Symptoms and the patient should be instructed to notify the physician immediately if they occur see also PRECAUTIONS ; . GLUCOPHAGE and GLUCOPHAGE XR should be withdrawn until the situation is clarified. Serum electrolytes, ketones, blood glucose and, if indicated, blood pH, lactate levels, and even blood metformin levels may be useful. Once a patient is stabilized on any dose level of GLUCOPHAGE or GLUCOPHAGE XR, gastrointestinal symptoms, which are common during initiation of therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease. Levels of fasting venous plasma lactate above the upper limit of normal but less than 5 mmol L in patients taking GLUCOPHAGE or GLUCOPHAGE XR do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling. See also PRECAUTIONS . ; Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis ketonuria and ketonemia ; . Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking GLUCOPHAGE or GLUCOPHAGE XR, the drug should be discontinued immediately and general supportive measures promptly instituted. Because metformin hydrochloride is dialyzable with a clearance of up to 170 mL min under good hemodynamic conditions ; , prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery. See also CONTRAINDICATIONS and PRECAUTIONS . ; PRECAUTIONS General and isosorbide.
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The cost of these medications to the ODB Program is shown in Exhibit 3.2. Costs associated with each drug class declined between 1996 and 1997, at which time the ODB Program introduced a co-payment and deductible plan, resulting in a global reduction in expenditures for the program. Insulin accounted for the highest portion of drug costs, showing a 46% increase over the time period studied. Reasons for this increase are likely multi-factorial, although there are more people taking insulin, as shown in Exhibit 3.1. In addition, higher doses of insulin are being used. The average number of units of insulin prescribed per person per month has increased from 1, 662 units in early 1997 to 1, 907 units in late 2001. Finally, the cost of insulin being prescribed increased, as newer, more expensive preparations became available. In 2001, over $14 million was spent on insulin, not including the additional cost of insulin syringes. The average annual cost to the ODB Program for sulfonylureas was $61.88 person in 2001. The cost of biguanides was $108.99 person; alpha-glucosidase inhibitors was $169.44 person; meglitinides was $170.71 person; and, thiazolidinediones was $295.16 person. The cost of insulin was $373.09 person. The daily cost of usual doses for each anti-hyperglycemic medication is shown in Technical Appendix TA3.B. Exhibit 3.3 shows the distribution of anti-hyperglycemic treatment regimens among all those with DM on April 1, 1999. About 40% of people did not use anti-hyperglycemic medications. About 29% took a single oral anti-hyperglycemic drug, while 17% took more than one type of medication. Insulin was used alone by 11% of people with DM and in combination with oral medications by another 3%. There was little variation range: 51.4% to 71.5% ; between counties in the use of these medications in 1999 and glucotrol.
Wood * * department of physiology and cell biology, college of medicine, the ohio state university, columbus, oh, usa * department of physiology and cell biology, college of medicine, the ohio state university, columbus, oh, usa † department of surgery, college of medicine, the ohio state university, columbus, oh, usa ‡ department of anesthesiology, college of medicine, the ohio state university, columbus, oh, usa § novartis pharmaceuticals corp.
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