Medication breakthroughs!

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New, amazing drugs for arthritis, migraines, prostate problems, osteoporosis, cancer and more

The last time you got a prescription, your doctor may have thumbed through an imposing tome called the Physician's Desk Reference, or PDR. The PDR is a physician's best friend. It explains in painstaking detail the proper uses, potential misuses and possible side effects of thousands of drugs. It's an impressive--and expensive--piece of work. Yet every year it's tossed in the trash and replaced. Why? Because new drugs are constantly being developed. "It's hard to keep up," says Joseph Barone, Pharm.D., chairman of pharmacy practice at Rutgers University School of Pharmacy, in New Jersey. "With new technology, such as genetic engineering, we're seeing new drug breakthroughs more often than ever before."

Here are some of those breakthroughs, chosen by a panel of medication experts from the American Pharmaceutical Association.
MIGRAINES

Sumatriptan is a new drug that researchers say can stop migraine-headache pain at the source--often within minutes. It works on receptor sites at nerve endings and blood vessels in the brain--sites that have become inflamed, leading to migraine headache. An auto-injector allows a patient to self-inject and abort a migraine attack. "This in turn can help short-circuit the events leading to the migraine cascade," says Robert W. Rosum, team pharmacist at New England Headache Treatment Program, at Greenwich Hospital in Greenwich, Connecticut.

In one study, 734 people with migraine headaches were given injections of sumatriptan during attacks. After one hour, nearly half said their headaches were completely relieved, while 70 percent reported at least some reduction in their symptoms.

Sumatriptan can be taken both by injection and orally (although the oral form is not yet available in this country) and appears to cause little discomfort. "The side-effect profile has been excellent. To date, a few isolated cases of artery constriction have been reported. Prior to using this medication, a thorough medical checkup by a physician is needed to rule out contraindications, including hypertension, cardiac disease and risk for stroke," says Rosum.
PROSTATE PROBLEMS

With a prescription drug called-finasteride, men with painfully enlarged prostate glands may be able to dodge the knife. "Great stuff! Major discovery!" says E. Don Nelson, Pharm.D., an associate professor of clinical pharmacology at the University of Cincinnati.

For an older man, the only thing in life that is nearly as certain as taxes is prostate problems. This pesky gland, which surrounds the urethra and produces seminal fluid, has a tendency to grow and grow and grow. It eventually may get so large that it presses on the urethra, blocking the flow of urine from the bladder.

Until recently, surgery was the only cure for this condition, called benign prostatic hyperplasia. But finasteride, for many men, provides another option. "One of the hopes is that we can control this problem with drug therapy and avoid surgery," says Daniel A. Hussar, Ph.D., a professor of pharmacy at Philadelphia College of Pharmacy and Science. This can be particularly important for men who either don't want surgery or who, because of other health problems, are considered poor surgical risks.

In one study, more than 50 percent of men taking finasteride had a 20 percent (or better) reduction in prostate size. Seventy-one percent reported improved symptoms, such as increased urine flow.

Finasteride isn't without problems, however. For example, it works at glacial speed--some men take it for six months or longer before getting relief. And some men will not experience relief of symptoms even after taking the drug for several months. For some of those who find relief, continued use of the drug can provide continued relief. But many men who take the drug eventually need surgery anyway. "It really doesn't work for everybody," says Dr. Hussar.
OSTEOPOROSIS

Osteoporosis is the bone-thinning disease that usually strikes women after menopause and can cause bones to become progressively weaker and more prone to breaking. Osteoporosis can be especially serious in people taking steroids--for rheumatoid arthritis, for example--which further leech calcium from bones.

A prescription drug called calcitonin can stop bone loss fast. Unfortunately, it's always been given by injection. However, a new form of calcitonin now can be given in a nasal spray. This means the same amount of protection without the ouch. In one study, 31 people with steroid-related osteoporosis were given either calcitonin nose spray or an inactive nose spray. After one year, the researchers found that women using the inactive spray had three times the spinal bone loss compared with women taking the calcitonin spray. "Whether it has long-lasting effects, I don't think we know yet. But it looks promising," says Peter P. Lamy, Ph.D., professor of geriatric pharmacotherapy and family and preventive medicine, University of Maryland.
PAIN

Now there's a radically different way to control postoperative or cancer pain. It's called patient-controlled analgesia (PCA). It allows the patient to self-administer intravenous painkillers whenever she feels the need, rather than waiting to have someone else give prescribed doses on a specified schedule. A PCA system consists of a continuous infusion pump controlled by a computer. When pain increases, the patient presses a button and receives intravenous relief. The device can be programmed to guard against overdoses.

"Many patients are using PCA very effectively," says Dr. Hussar. "The benefits are that there can be better relief or control of pain, and the patient is in control of her own medication."

PCA is an answer to a common problem in postoperative or cancer pain: Such discomfort doesn't always parallel a standard dosing schedule. Pain can recur before the next scheduled dose is administered. Curiously, in some research, when patients were first put on PCA, they gave themselves more painkiller than a prescribing physician would have. But over time the patients wound up giving themselves less medication than would have been provided by a typical dosage regimen.

PCA is now widely available and is used in cancer treatment and after many different surgical procedures.
GAUCHER'S DISEASE

Children who are born with a condition called Gaucher's disease are missing an enzyme called glucocerebrosidase. Without this enzyme, normal metabolism goes awry. Anemia and enlarged internal organs may result. There has simply been no treatment for Gaucher's disease--until now. Today, says Dr. Hussar, the disease can be stopped cold with a prescription drug called alglucerase. "There is no question that this is really a breakthrough drug."

Alglucerase, which works by replacing the missing enzyme, is given intravenously, usually every two weeks, although it may be given every other day. It has enabled children with Gaucher's disease to live essentially normal lives by helping to relieve their symptoms. However, adds Dr. Hussar, it isn't a cure. "It's kind of like insulin. It's a lifelong treatment."
KIDNEY STONES

Most kidney stones are quite small, more like tiny crystals than real stones. But people who actually have had this excruciatingly painful problem may be forgiven for imagining them to be much bigger--about the size of rocks or boulders, perhaps. Certainly not a small stone!

A serious problem with kidney stones is that once you've had them removed, whether with surgery or a newer technique called shock-wave lithotripsy, there's a very good chance they'll come back. That's why doctors frequently depend on drug therapy to prevent future problems.

Most people with recurring kidney stones have a condition called hypercalciuria--too much calcium in the urine. In the past, drugs used to reduce urinary calcium also tended to raise cholesterol levels. And because people who take drugs for kidney stones take them for life, these high cholesterol levels were a problem.

Doctors, however, have begun using a prescription drug called indap-pamide. Originally taken for high blood pressure, indapamide has been found to help prevent kidney stones as well. Better yet, it doesn't change the lipid level as much as the other ones do. However, it could cause excessive potassium loss. But just taking the drug isn't enough. It's very important for all people prone to stones to drink plenty of water--at least eight glasses every day. This helps dilute minerals in the urine and keep them flowing before they cause problems.
CANCER

Taxol Harvested from the bark of the western yew tree, this powerful prescription drug has been effective at fighting ovarian cancers that may not respond to other treatments.

"It's definitely unique," says Lea Ann Hansen, Pharm.D., an assistant professor of pharmacy and pharmaceutics at Medical College of Virginia Hospitals, Virginia Commonwealth University. "It's been shown that in patients who haven't responded very well to other types of chemotherapy, their tumors get smaller for a fairly long time after getting taxol." In one study, researchers at Johns Hopkins Oncology Center, in Baltimore, gave taxol intravenously every 22 days to 47 women with a drug-resistant type of ovarian cancer.

In 30 percent of the women's cases, tumor size was reduced for 3 to 15 months, a performance researchers called "remarkable."

As with many cancer drugs, taxol suppresses the production of white blood cells, a process that can lead to infections. There's also a serious supply problem: The tree from which taxol currently is extracted is an endangered species. That's why researchers are investigating other sources for the drug, says Dr. Hansen.

Aldesleukin This new prescription drug, says Dr. Hussar, "is really the first drug to be considered effective for renal-cell carcinoma, or kidney cancer. It's more effective than anything else out there."

Aldesleukin is modeled after key proteins in the immune system called interleukins. Like these proteins, it's designed to destroy foreign invaders--specifically, cancer cells that invade the kidneys.

Aldesleukin is a very significant advance, but it isn't a magic bullet, he adds. "Only about 15 percent of patients treated with the drug experienced either a complete or partial response," he says.

Still, every advance in the cancer war is significant. "Different kinds of cancers respond in different and specific ways to different drugs," says Dr. Nelson. "I would say this is going to be a useful agent."

Filgrastim This new prescription drug can help strengthen the immune system during chemotherapy. Without this protection, says Dr. Hussar, cancer patients have a greater risk of developing serious infections, which can interrupt their treatments.

With filgrastim, at least some infections can be prevented. Says Dr. Hussar, "Oncologists are enthusiastic. By having a more rapid return of white-blood-cell levels, we can reduce the risk of complications." This in turn may allow more aggressive treatments of the cancer--and perhaps a better chance for a cure.

The major side effect of filgrastim is bone pain, which is usually mild, doctors say, and can be controlled with over-the-counter painkillers, such as acetaminophen.
LEAD POISONING

Lead is everywhere--in old paints, ceramics and glassware. When it's accidentally ingested, it can cause mental retardation--including learning problems-- kidney damage and other serious problems. Until recently, the only drugs available for removing lead from the body were given by injection--sometimes more than once. Children, usually the victims of lead poisonings, didn't enjoy the treatments. A new prescription drug called succimer, however, appears to be more effective. Better yet, it's taken orally--two to three times a day for up to 19 days. "It's the first really effective, low-toxicity oral agent," says Cheston M. Berlin, M.D., a professor of pediatrics and pharmacology at Pennsylvania State University.

Succimer works by binding to lead in the bloodstream, then ferrying it out of the body in the urine. To keep things flowing, it's important that a child drink plenty of water during the treatments, says Dr. Berlin. This helps the kidneys efficiently flush lead from the body. Side effects may include nausea, vomiting, diarrhea, abdominal cramps and a metallic taste.

ILLUSTRATION: (JAMES ENDICOTT)

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By AMERICAN PHARMACEUTICAL ASSOCIATION

The American Pharmaceutical Association is a national professional society of pharmacists, representing 40,000 members. APhA is a leader in the professional and scientific advancement of pharmacy and in safeguarding the well-being of the individual patient.

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