RESUMEN
Heart failure is a health problem worldwide. There are some drugs for it, including digoxin, spironolactone, captopril, and valsartan, but some of these drugs can produce secondary effects, such as arrhythmia, cough, hyperkalemia, hyponatremia and hypotension. The aim of this research was to evaluate the biological activity of coumarin (2H-chromen-2-one) and its derivatives (3BrAcet-C, 3-4Br-Ph-C, 4-CN-7D-C, 4-Me-7-Ph-C and 6Br-3-D-C) against ischemia/reperfusion injury as a therapeutic alternative for heart failure. In addition, the biological activity of the coumarin derivative 4-Me-7-Ph-C on left ventricular pressure (LVP) was determined in the absence or presence of ouabain and nifedipine at a dose of 1 nM using an isolated rat heart model. The results showed that i) the coumarin derivative 4-Me-7-Ph-C significantly decreased the infarct area (p+=+0.05) compared with 3BrAcet-C, 3-4Br-Ph-C, 4-CN-7D-C, and 6Br-3-D-C; and ii) 4-Me-7-Ph-C increased LVP in a dose-dependent manner, which effect was inhibited by nifedipine. These data suggest that coumarin 4-Me-7-Ph-C may act as a type-L calcium channel activator, so it could be a good agent to treat heart failure.
Asunto(s)
Insuficiencia Cardíaca , Daño por Reperfusión Miocárdica , Ratas , Animales , Nifedipino/farmacología , Nifedipino/uso terapéutico , Daño por Reperfusión Miocárdica/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Cumarinas/farmacología , Cumarinas/uso terapéutico , Isquemia , CorazónRESUMEN
BACKGROUND: Topical treatments and botulinum toxin injections are valid options for the management of patients with chronic anal fissures (CAF), but little is known about the efficacy of these techniques in long-term follow-up. The aim of this meta-analysis was to evaluate the effectiveness, given to clinical outcomes, of medical treatments with calcium antagonists, nitroglycerin, and botulinum toxin on CAF treatment in adults. METHOD: A systemic review and meta-analysis developed according to PRISMA [PLoS Med. 2009 Jul 21;6(7):e1000100; BMJ. 2010 Mar 23;340:c332] and registered in PROSPERO (Registration number: CRD42020120386). A systematic literature search was conducted through MEDLINE, EMBASE, Web of Science, and Cochrane Library databases. Randomized control trials that compared medical treatment were identified; publications had to have a clinical definition of CAF with at least one of the following signs or symptoms: visible sphincter fibers at the base of the fissure, anal papillae, sentinel piles, and indurated margins. The symptoms had to be chronic for at least 4 weeks. Data were independently extracted for each study, and a meta-analysis was drawn using fixed- and random-effects models. RESULTS: 17 randomized trials met the inclusion criteria. Diltiazem showed a superior effect compared with glycerin (RR = 1.16 [95% CI = 1.05-1.30]; I2 = 18%) and with fewer adverse effects (RR = 0.13 [95% CI = 0.04-0.042]; I2 = 87%). Similar results were evidenced with the use of nifedipine compared with lidocaine (RR = 4.53 [95% CI = 2.99-6.86]; I2 = 28%). Botulinum toxin did not show statistically significant differences compared to glycerin (RR = 0.81 [95% CI = 0.02-29.36]; I2 = 93%) or isosorbide dinitrate (RR = 1.45 [95% CI = 0.32-6.54]; I2 = 85%). Regarding recurrence, nifedipine was superior to lidocaine (RR = 0.18 [95% CI = 0.08-0.44]; I2 = 31%). CONCLUSIONS: Calcium channel blockers performed well regarding the healing of CAF when compared to others in long-term follow-up. The superiority of botulinum toxin was not evidenced compared to topical treatments. More studies are needed to better assess recurrence rates.
Asunto(s)
Fisura Anal , Adulto , Humanos , Fisura Anal/tratamiento farmacológico , Nifedipino/uso terapéutico , Glicerol/uso terapéutico , Resultado del Tratamiento , Nitroglicerina/uso terapéutico , Enfermedad CrónicaRESUMEN
Proveer recomendaciones clínicas basadas en evidencia para la prevención y el manejo de la enfermedad hipertensiva del embarazo (EHE) en el Seguro Social de Salud (EsSalud) del Perú. En la presente GPC se formularon 11 recomendaciones (6 fuertes y 5 condicionales) que respondieron las preguntas clínicas definidas en el alcance de la GPC, acompañadas de 32 puntos de BPC y 3 flujogramas que abordan temas de prevención, tratamiento y seguimiento de la EHE.
Asunto(s)
Humanos , Femenino , Embarazo , Preeclampsia/tratamiento farmacológico , Servicios de Salud Materno-Infantil/normas , Complicaciones del Embarazo , Embarazo , Nifedipino/uso terapéutico , Aspirina/uso terapéutico , Hidralazina/uso terapéutico , Labetalol/uso terapéuticoRESUMEN
O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 22 artigos e 10 protocolos.
Asunto(s)
Humanos , Neumonía Viral/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Progresión de la Enfermedad , Betacoronavirus/efectos de los fármacos , Inmunoglobulinas/uso terapéutico , Metilprednisolona/uso terapéutico , Nifedipino/uso terapéutico , Cloroquina/uso terapéutico , Amlodipino/uso terapéutico , Corticoesteroides/uso terapéutico , Azitromicina/uso terapéutico , Ritonavir/uso terapéutico , Fluoroquinolonas/uso terapéutico , Combinación de Medicamentos , Lopinavir/uso terapéutico , Interferón alfa-2/uso terapéutico , Amoxicilina/uso terapéutico , Hidroxicloroquina/uso terapéuticoRESUMEN
Abstract Background The human skin is an extremely sophisticated and evolved organ that covers the whole body. External agents or the patient's own diseases can cause skin injuries that can challenge healthcare professionals and impose high social, economic and emotional costs. Objectives To evaluate the impact of topical nifedipine on skin wound healing, specifically on polymorphonuclear cells, vascular proliferation, and collagen. Methods We used three pigs, and created eight injuries in the dorsal region of each animal. We applied 1%, 10%, and 20% concentration nifedipine creams to four of the wounds in animals 1, 2, and 3 respectively and treated the other twelve wounds with saline solution 0.9% only. We analyzed the presence of polymorphonuclear cells, vascular proliferation, and collagen at six different times (days 1, 3, 7, 14, 21, and 28). Results The evaluation of polymorphonuclear levels showed mild cell activity at all times in the control group, while in the nifedipine groups, marked levels were more frequent at all times during the experiment. There was a 4.84-fold increase in the chance of marked vascular proliferation (p = 0.019) and, at the same time, a decrease in collagen formation (OR 0.02 / p = 0.005) in animal 3. Conclusions Topical NFD may have an impact on skin wound healing mechanisms. Our study showed that polymorphonuclear cells and vascular proliferation increased. We also demonstrated that collagen formation decreased. Therefore, topical NFD may have a positive impact on skin wound healing. Additional studies are needed to confirm our results.
Resumo Contexto A pele humana é um órgão extremamente sofisticado e evoluído que cobre todo o corpo. As lesões cutâneas podem ser causadas por agentes externos ou pelas próprias doenças do paciente, e podem representar um desafio para os profissionais de saúde com altos custos sociais, econômicos e emocionais. Objetivos Avaliar o impacto da nifedipina tópica na cicatrização de feridas cutâneas, especialmente em relação a polimorfonucleares, proliferação vascular e colágeno. Métodos Utilizamos três porcos e realizamos oito ferimentos na região dorsal de cada animal. Aplicamos as concentrações de nifedipina creme a 1%, 10% e 20% para os animais 1, 2 e 3, respectivamente, sendo que, em quatro ferimentos, aplicamos o creme e, nos outros quatro ferimentos, apenas soro fisiológico a 0,9%. Analisamos a presença de polimorfonucleares, proliferação vascular e colágeno em seis momentos diferentes (dias 1, 3, 7, 14, 21 e 28). Resultados A avaliação dos níveis polimorfonucleares mostrou atividade celular discreta em todos os momentos no grupo controle, enquanto nos grupos nifedipina, os níveis marcados foram mais frequentes em todos os momentos do experimento. Houve aumento de 4,84 vezes na chance de uma produção marcada (p = 0,019) da proliferação vascular e, ao mesmo tempo, diminuição da formação do colágeno (odds ratio, OR 0,02; p = 0,005) no animal 3. Conclusões A nifedipina tópica pode ter impacto no mecanismo de cicatrização cutânea. Nosso estudo mostrou que há aumento dos polimorfonucleares e da proliferação vascular. Além disso, há diminuição da formação do colágeno. Assim, a nifedipina tópica pode ter impacto positivo na cicatrização das feridas cutâneas. Estudos adicionais são necessários para confirmar nossos resultados.
Asunto(s)
Humanos , Animales , Piel/lesiones , Cicatrización de Heridas/efectos de los fármacos , Nifedipino/uso terapéutico , Porcinos , Administración Cutánea , Nifedipino/administración & dosificación , Colágeno/sangre , Modelos AnimalesRESUMEN
A vasculopatia livedoide é uma doença rara caracterizada pela oclusão da microvasculatura da derme, originando lesões maculosas que, posteriormente, podem evoluir para úlceras e cicatrizes atróficas. Como um fenômeno vaso-oclusivo, o tratamento geralmente é realizado com antiplaquetários e fibrinolíticos. O presente relato descreve o caso de uma paciente refratária à terapia convencional, que obteve regressão da doença utilizando a rivaroxabana, um fármaco inibidor seletivo do fator Xa. (AU)
Livedoid vasculopathy is a rare disease characterized by occlusion of the dermis microvasculature, leading to spotted lesions that can later develop into ulcers and atrophic scars. As a vaso- occlusive phenomenon, treatment is usually performed with antiplatelet and fibrinolytic agents. The present report describes the case of a female patient refractory to conventional therapy who presented disease remission using rivaroxaban, a selective factor Xa inhibitor drug. (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trombosis/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Microangiopatías Trombóticas/tratamiento farmacológico , Rivaroxabán/uso terapéutico , Vasculopatía Livedoide , Parestesia , Pentoxifilina/uso terapéutico , Polineuropatías/diagnóstico , Trombosis/complicaciones , Vasodilatadores/uso terapéutico , Biopsia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Nifedipino/uso terapéutico , Fibromialgia , Enfermedades Cutáneas Vasculares/complicaciones , Enfermedades Cutáneas Vasculares/diagnóstico , Enfermedades del Tejido Conjuntivo/complicaciones , Extremidad Inferior/lesiones , Electromiografía , Microangiopatías Trombóticas/complicaciones , Inhibidores del Factor Xa/uso terapéutico , Pie/patología , Enfermedades Diverticulares , Fumadores , Gabapentina/uso terapéutico , Analgésicos/uso terapéuticoRESUMEN
CONTEXTO: Ureterolitotripsia, ULT, é o tratamento de escolha para o cálculo ureteral e vem sendo realizada há mais de 20 anos no Brasil em serviços privados e em alguns hospitais-escola. Entretanto, ainda não está incorporada ao SUS. TECNOLOGIA: Ureterolitotripsia. PERGUNTAS: A ULT é segura, efetiva e custo-efetiva em comparação ao procedimento disponível em primeira linha, a litotripsia extracorpórea por ondas de choque, LECO, para a remoção de cálculos ureterais? EVIDÊNCIAS CIENTÍFICAS: Pela revisão sistemática da literatura foi possível selecionar e reanalisar os estudos de 03 metanálises recentes, relevantes e com baixo risco de vieses. Nestas, concluiuse que a ULT está relacionada a um efeito 10% maior quando se avalia a liberação dos cálculos, com taxa de complicações similar à litotripsia extracorpórea por ondas de choque, LECO. Na literatura internacional a ULT é considerada o procedimento de primeira escolha para o tratamento de cálculos ureterais proximais e distais por estar relacionada a alta eficiência e baixa morbidade quando comparada aos demais procedimentos para a remoção de cálculos ureterais. AVALIAÇÃO ECONÔMICA: A avaliação econômica em nosso meio mostra que a ULT é menos custoefetiva que a litotripsia extracorpórea por ondas de choque, LECO. As comparações internacionais mostram relações de custo-efetividade mais favoráveis ao procedimento por ULT em relação aos demais para a remoção de cálculos ureterais incluindo a LECO. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A partir da movimentação das autorizações de internação hospitalar, AIH, atribuíveis à litíase ureteral proximal grave, estima-se que entre 10.000 e 15.000 pacientes poderiam ser beneficiados pela incorporação da ULT (de 9% até 13,6% dos 110.000 pacientes tratados com LECO ambulatoriamente). Considerando-se o custo adicional de R$ 3.475,39 encontrado em hospital de São Paulo (microcusteio), a verba orçamentária local investida variou entre R$ 34.753.900,00 e R$ 52.130.850,00. Considerando uma média global (do valor na Tabela do SUS ponderado pela proporção de cirurgias) de ressarcimento de R$ 754,17, os 10.000 a 15.000 procedimentos de ULT, que já estão sendo realizados, teriam um impacto orçamentário adicional de R$ 568.644,42 até R$ 4.339.495,99. As principais limitaçõesincluem a heterogeneidade nos estudos, o estudo local foi retrospectivo, houve avaliação parcial das taxas e custos dos eventos adversos e complicações da LECO, os custos pagos no pregão público do Estado de São Paulo são menores que nas outras fontes de dados (por exemplo, materiais e medicamentos no Banco de Preços em Saúde (BPS) do Ministério da Saúde). CONCLUSÃO: A evidência atualmente disponível sobre eficácia e segurança da ULT para tratamento de cálculos ureterais proximais está baseada em dezenas de estudos randomizados e prospectivos, com nível de evidência 1B e grau forte de recomendação. Os resultados apresentados pelos estudos meta-analíticos mostram resolutividade da ULT 10% maior que o método de LECO (sucesso de mais pacientes livres de cálculos ureterais dentre os tratados) e taxa de complicações similares às da litotripsia extracorpórea por ondas de choque, LECO. O modelo para estimar a relação de custo-efetividade com base nos dados empíricos observados em nosso meio mostrou custo adicional da ULT, embora as publicações internacionais recentes, em que se revisaram as relações de custo-efetividade, apontem para um favorecimento da ULT como mais eficiente em comparação com a LECO. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Os membros do Plenário presentes em sua 72ª reunião ordinária, no dia 08 de novembro de 2018, indicaram que o tema seja submetido à Consulta Pública com recomendação preliminar favorável à incorporação no SUS da ureterolitotripsia condicionada à não ocorrência de custos incrementais em relação aos procedimentos comparados. Considerou-se que a técnica tem maior resolutividade e possui taxa de complicações similares ao procedimento disponível no SUS. CONSULTA PÚBLICA: A consulta pública n° 01 de 2019 foi realizada entre os dias 12/01/2019 e 31/01/2019. Foram recebidas 78 contribuições sendo 21 pelo formulário para contribuições técnico-científicas e 57 pelo formulário para contribuições sobre experiência ou opinião. No conjunto das contribuições, 92,3% do total foram enviadas por profissionais de saúde. Em 90% das contribuições enviadas afirma-se concordância total com a recomendação preliminar. Entre as discordâncias parciais alegou-se que a ressalva de equiparação de valores entre os procedimentos utilizados em litíase do trato urinário pode prejudicar a disponibilização dessa tecnologia no SUS e que seria necessário formalizar um algoritmo para otimizar o uso dos recursos mais complexos para os estratos de maior complexidade do tratamento dessa doença. Entre os documentos técnicos recebidos, 2 artigos e 1 citação foram encaminhados, todos 3 já incluídos nas revisões sistemáticas e Diretrizes utilizadas para estruturar e descrever as evidências científicas que embasaram o presente relatório técnico da CONITEC. Entendeu-se que as contribuições submetidas não trouxeram argumentação suficiente para modificar a recomendação preliminar. RECOMENDAÇÃO FINAL: Após a apresentação no dia 07 de fevereiro de 2019 do consolidado das 78 contribuições recebidas na consulta pública n° 1 de 2019, os membros da CONITEC presentes na 74ª reunião ordinária deliberaram, por unanimidade, que fosse ratificada a recomendação inicial favorável à incorporação da ureterolitotripsia transureteroscópica para litíase do trato urinário, condicionada à não ocorrência de custos incrementais aos procedimentos comparados. Nesta data, assinou-se o registro de deliberação nº. 422/2019 pela incorporação da tecnologia. DECISÃO: Incorporar a ureterolitotripsia transureteroscópica para litíase do trato urinário, no âmbito do Sistema Único de Saúde - SUS. Dada pela Portaria nº 15, publicada no Diário Ofical da União nº 54, seção 1, página 66, em 22 de março de 2019.
Asunto(s)
Humanos , Litotricia/métodos , Nifedipino/uso terapéutico , Ureterolitiasis/cirugía , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economíaRESUMEN
This work investigated the acute effects of the calcium channel blocker nifedipine and its new fatty hybrid derived from palmitic acid, 3,5-dipalmitoyl-nifedipine, compared to endocannabinoid anandamide during the process of inducing ischemia and reperfusion in cardiomyoblast H9c2 heart cells. The cardiomyoblasts were treated in 24 or 96-well plates (according to the test being performed) and maintaining the treatment until the end of hypoxia induction. The molecules were tested at concentrations of 10 and 100µM, cells were treated 24h after assembling the experimental plates and immediately before the I/R. Cell viability, apoptosis and necrosis, and generation of reactive oxygen species were evaluated. Nifedipine and 3,5-dipalmitoyl-nifedipine were used to assess radical scavenging potential and metal chelation. All tested molecules managed to reduce the levels of reactive oxygen species compared to the starvation+vehicle group. In in vitro assays, 3,5-dipalmitoyl-nifedipine showed more antioxidant activity than nifedipine. These results indicate the ability of this molecule to act as a powerful ROS scavenger. Cell viability was highest when cells were induced to I/R by both concentrations of anandamide and the higher concentration of DPN. These treatments also reduced cell death. Therefore, it was demonstrated that the process of hybridization of nifedipine with two palmitic acid chains assigns a greater cardioprotective effect to this molecule, thereby reducing the damage caused by hypoxia and reoxygenation in cardiomyoblast cultures.
Asunto(s)
Cardiotónicos/farmacología , Miocitos Cardíacos/efectos de los fármacos , Nifedipino/farmacología , Ácido Palmítico/farmacología , Daño por Reperfusión/prevención & control , Animales , Bloqueadores de los Canales de Calcio/química , Bloqueadores de los Canales de Calcio/farmacología , Bloqueadores de los Canales de Calcio/uso terapéutico , Cardiotónicos/química , Cardiotónicos/uso terapéutico , Supervivencia Celular/efectos de los fármacos , Supervivencia Celular/fisiología , Células Cultivadas , Relación Dosis-Respuesta a Droga , Miocitos Cardíacos/patología , Nifedipino/química , Nifedipino/uso terapéutico , Ácido Palmítico/química , Ácido Palmítico/uso terapéutico , Ratas , Ratas Wistar , Daño por Reperfusión/patologíaRESUMEN
BACKGROUND: Ureteric colic is the most common symptom of lithiasis. It is caused by the presence of stones accumulated in the renal papillae. These stones often migrate down the ureter, causing a ureteric colic, characterized by a severe pain in the lumbar region. The aim of this study was to compare the use of ketorolac and nifedipine vs. ketorolac and tamsulosin for the medical treatment of pain caused by stones in the lower ureter. METHODS: Longitudinal study of 150 patients of 21-years or older with stones in the lower third of the ureter. 50% received ketorolac and nifedipine and the other 50%, ketorolac and tamsulosin. The Numeric Pain Rating Scale (NPRS) was used for the assessment of pain at admission and 4 and 12 hours after the treatment was administered. We used descriptive and inferential statistics (Mann-Whitney-Wilcoxon, chi-squared and Poisson regression). RESULTS: Mean age was 38.17 years; 54.7% were male and 45.3% female. NPRS mean was 9.69 (initially), 7.42 (at 4 hours) and 2.05 (at 12 hours). There were no significant differences in the initial measurement of pain between groups (p < 0.005); four and 12 hours later the pain decreased more in patients managed with ketorolac and nifedipine, p = 0.0041. There were no complications nor side effects in both treatments. CONCLUSION: The use of ketorolac and nifedipine is more effective than the use of ketorolac and tamsulosin for the management of pain caused by lower ureteral colic during the first 12 hours of treatment.
Introducción: el cólico renoureteral es la manifestación más común de la litiasis. Se trata de la presencia de cálculos en las papilas renales que frecuentemente migran hacia el uréter, ocasionando un cólico renoureteral, caracterizado por un dolor intenso en la región lumbar o en sus flancos. Se buscó comparar el uso del ketorolaco y nifedipino frente a ketorolaco y tamsulosina para el manejo del dolor ocasionado por litiasis en el tercio inferior del uréter. Métodos: estudio longitudinal en 150 pacientes mayores de 21 años con litiasis en tercio inferior del uréter. Al 50% se le administró ketorolaco y nifedipino y al otro 50% ketorolaco y tamsulosina. Se utilizó la escala numérica de dolor (END) al ingreso, a las 4 y a las 12 horas. La estadística fue descriptiva e inferencial (U de Mann-Whitney-Wilcoxon, chi cuadrada y regresión de Poisson). Resultados: la edad promedio fue 38.17 años y 54.7% de los pacientes fueron hombres. Inicialmente la END tuvo una media de 9.69, de 7.42 a las 4 horas y de 2.05 a las 12 horas. En la medición inicial del dolor no hubo diferencias significativas entre ambos grupos (p > 0.005); 4 y 12 horas después el dolor disminuyó más en los pacientes manejados con ketorolaco y nifedipino: p = 0.0041 y p = 0.000, respectivamente. No hubo complicaciones ni efectos secundarios en ambos tratamientos. Conclusión: la mancuerna ketorolaco y nifedipino es más efectiva que la del ketorolaco y la tamsulosina para el manejo del dolor del cólico renoureteral inferior durante las primeras 12 horas de tratamiento.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Servicio de Urgencia en Hospital , Ketorolaco/uso terapéutico , Nifedipino/uso terapéutico , Cólico Renal/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Agentes Urológicos/uso terapéutico , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Cólico Renal/diagnóstico , Tamsulosina , Resultado del TratamientoRESUMEN
AIMS: Diabetes mellitus can inhibit cytochrome P450 3A4, an enzyme responsible for the metabolism of nifedipine, used for the treatment of hypertension in pregnant women. We aimed to assess the effect of type 2 diabetes mellitus (T2DM) on the pharmacokinetics, placental transfer and distribution of nifedipine in amniotic fluid in hypertensive pregnant women. METHODS: The study was conducted in 12 hypertensive pregnant women [control group (CG)] and 10 hypertensive pregnant women with T2DM taking slow-release nifedipine (20 mg, 12/12 h). On the 34th week of gestation, serial blood samples were collected (0-12 h) after administration of the medication. At delivery, samples of maternal and fetal blood and amniotic fluid were collected for determination of nifedipine distribution in these compartments. RESULTS: The median pharmacokinetic parameters of CG were: peak plasma concentration (Cmax ) 26.41 ng ml-1 , time to reach Cmax (tmax ) 1.79 h, area under the plasma concentration vs. time curve from 0-12 h (AUC0-12 ) 235.99 ng.h ml-1 , half-life (t½) 4.34 h, volume of distribution divided by bioavailability (Vd/F) 560.96 l, and ClT /F 84.77 l h-1 . The parameters for T2DM group were: Cmax 23.52 ng ml-1 , tmax 1.48 h, AUC0-12 202.23 ng.h ml-1 , t½ 5.00 h, Vd/F 609.40 l, and apparent total clearance (ClT /F) 98.94 l h-1 . The ratios of plasma concentrations of nifedipine in the umbilical vein, intervillous space and amniotic fluid to those in the maternal vein for CG and T2DM were 0.53 and 0.44, 0.78 and 0.87, respectively, with an amniotic fluid/maternal plasma ratio of 0.05 for both groups. The ratios of plasma concentrations in the umbilical artery to those in the umbilical vein were 0.82 for CG and 0.88 for T2DM. CONCLUSIONS: There was no influence of T2DM on the pharmacokinetics or placental transfer of nifedipine in hypertensive women with controlled diabetes.
Asunto(s)
Bloqueadores de los Canales de Calcio/farmacocinética , Citocromo P-450 CYP3A/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Hipertensión/tratamiento farmacológico , Nifedipino/farmacocinética , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Adulto , Líquido Amniótico/química , Líquido Amniótico/efectos de los fármacos , Disponibilidad Biológica , Bloqueadores de los Canales de Calcio/uso terapéutico , Estudios de Casos y Controles , Preparaciones de Acción Retardada/farmacocinética , Preparaciones de Acción Retardada/uso terapéutico , Femenino , Semivida , Humanos , Nifedipino/uso terapéutico , Placenta/metabolismo , EmbarazoRESUMEN
BACKGROUND: Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. OBJECTIVE: Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. CLINICAL CASE: The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. CONCLUSION: It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.
Asunto(s)
Abdomen Agudo/etiología , Seudoobstrucción Colónica/inducido químicamente , Motilidad Gastrointestinal/efectos de los fármacos , Perforación Intestinal/etiología , Anciano , Anastomosis Quirúrgica/métodos , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Atorvastatina/efectos adversos , Atorvastatina/uso terapéutico , Antagonistas Colinérgicos/efectos adversos , Antagonistas Colinérgicos/farmacología , Antagonistas Colinérgicos/uso terapéutico , Colon/cirugía , Colon Sigmoide/cirugía , Seudoobstrucción Colónica/fisiopatología , Seudoobstrucción Colónica/cirugía , Sinergismo Farmacológico , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Íleon/cirugía , Perforación Intestinal/cirugía , Cetoconazol/uso terapéutico , Levetiracetam , Meropenem , Nifedipino/efectos adversos , Nifedipino/farmacología , Nifedipino/uso terapéutico , Peritonitis/tratamiento farmacológico , Peritonitis/etiología , Piracetam/efectos adversos , Piracetam/análogos & derivados , Piracetam/uso terapéutico , Polifarmacia , Fumarato de Quetiapina/efectos adversos , Fumarato de Quetiapina/uso terapéutico , Clorhidrato de Raloxifeno/efectos adversos , Clorhidrato de Raloxifeno/uso terapéutico , Respiración Artificial , Factores de Riesgo , Tienamicinas/uso terapéuticoRESUMEN
UNLABELLED: The aim of this study was to evaluate the effects of perindopril or barnidipine alone or combined with simvastatin on metabolic parameters and hepatic steatosis degree. One hundred and forty nine mild to moderate hypertensive, normocholesterolemic, overweight or obese outpatients with hepatic steatosis were enrolled. They were treated with perindopril 5mg/day, or barnidipine, 20mg/day, for 6 months; subsequently simvastatin, 20mg/day was added to both treatments for further 6 months. Blood pressure variation was recorded. Patients also underwent an ultrasound examination, at baseline and after 6, and 12 months. We also assessed: fasting plasma glucose (FPG), fasting plasma insulin (FPI), lipid profile, adiponectin (ADN), tumor necrosis factor-α (ΤΝF-α), interleukin-6 (IL-6), high-sensitivity C reactive protein (Hs-CRP). Both perindopril and barnidipine reduced blood pressure, with barnidipine being more effective. Barnidipine, but not perindopril, slightly decreased total cholesterol and triglycerides after 6 months compared to baseline; lipid profile improved in both groups when simvastatin was added. Regarding inflammatory parameters, barnidipine reduced TNF-a, IL-6, and Hs-CRP, both in monotherapy, and after simvastatin addition. Hepatic steatosis parameters improved only when simvastatin was added. We can conclude that barnidipine better reduced blood pressure compared to perindopril and inflammatory parameters. Regarding hepatic steatosis parameters, only the addition of simvastatin improved them. REGISTRATION NUMBER: NCT02064218, ClinicalTrials.gov.
Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Nifedipino/análogos & derivados , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Perindopril/uso terapéutico , Simvastatina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Nifedipino/uso terapéutico , Obesidad/tratamiento farmacológicoRESUMEN
Se realizó un estudio transversal en gestantes ingresadas con el diagnóstico de amenaza de parto pretérmino, en la sala de cuidados maternos-perinatales del Servicio de Obstetricia del Hospital General Docente Dr Ernesto Guevara de Las Tunas, con el objetivo de determinar la utilidad del tratamiento de la amenaza de parto pretérmino con el empleo de hidratación y nifedipino como terapéutica de elección, en una muestra de 86 gestantes con embarazo viable entre 28 y 34 semanas, que recibieron como tratamiento de ataque la hidratación endovenosa, el reposo en cama y el uso de bloqueadores de los canales del calcio. Se estudiaron como variables: edad materna, edad gestacional al ingreso, paridad, antecedentes personales, tiempo para la desaparición de los síntomas, estadía en la sala de cuidados maternos perinatales y tocolíticos empleados. Predominaron las gestantes de entre 20 y 24 años de edad; las de edad gestacional al ingreso entre 32 a 34 semanas, 37 casos para un 43,1 por ciento; las que tenían un parto anterior, 42 (48,8 por ciento). Los abortos espontáneos previos (26,7 por ciento) y el parto prematuro anterior (24,4 por ciento) resultaron los antecedentes patológicos maternos más significativos. El 53,6 por ciento de las gestantes necesitaron tres horas para la desaparición de los síntomas y tres días para estar de alta. El 89,6 por ciento pudo llegar al término de su gestación. El empleo de nifedipino e hidratación como tratamiento de elección en la amenaza de parto pretérmino se relacionó con la reducción en el tiempo de alivio de los síntomas, una menor estadía y la prolongación de la gestación, lo que hace a este esquema terapéutico como el más recomendable para la atención de este problema de salud en condiciones similares a la de la investigación(AU)
A cross-sectional study was carried out on expectant mothers diagnosed with threatened preterm labour attended at the perinatal care room of the Obstetrics Service at Dr Ernesto Guevara General Teaching Hospital of Las Tunas to determine the usefulness of the treatment of threatened preterm labour with hydration and nifedipine as a therapeutic choice. The sample included 86 women of among 28 and 34 weeks of pregnancy treated with intravenous hydration, bed rest and the use of calcium channel blockers. The variables under study were: mother´s age, gestational age at the moment of admission, parity, personal history, time for the symptoms´ disappearance, stay period at perinatal care room and tocolytics used. There was predominance of expectant mothers between 20 and 24 years old, with a gestational age of among 32 and 34 weeks, represented by 37 cases (43,1 percent) and of women with previous pregnancies 42 (48,8 percent). Previous spontaneous abortions (26,7 percent) and premature labours (24,4 percent) were most significant in the mother´s past medical history. 53,6 percent of the women needed 3 hours to experience no symptoms and three days for discharge and 89,6 percent was able to end the pregnancy. The treatment with nifedipine and hydration for threatened preterm labour was related to less time to relieve the symptoms, a shorter stay and longer duration of the pregnancy, making it the most recommendable therapeutic sheme to treat such health problem(AU)
Asunto(s)
Humanos , Embarazo , Tocólisis , Trabajo de Parto Prematuro/prevención & control , Nifedipino/uso terapéutico , Estudios TransversalesRESUMEN
PRIMARY OBJECTIVE: evaluation of Nifedipine protocol success defined as postponement of labor for 48 hours. SECONDARY OBJECTIVE: evaluation of the presence of risk factors in patients that develop preterm labor and delivery outcome. MATERIALS AND METHODS: Chart review retrospective study with patients admitted to the Hospital of the Metropolitan Area of San Juan in the period of January 1,2009 to December 31, 2010 with diagnosis of preterm labor. A total of 382 patient's records were evaluated for inclusion and exclusion criteria. 48 met all the requirements to be included in the study. RESULTS: There were 68.8% patients who successfully completed the 48 hours postponement of labor required to administer corticosteroid therapy for fetal lung maturation. Risk factors for preterm labor commonly observed in the study group were urinary tract infection (60.4%), previous preterm labor (43.8%), multiple gestations (12.5%), and preterm premature rupture of membranes (10.4%). DISCUSSION: The use of Nifedipine therapy in patients with preterm labor between 24-34 weeks of gestational age can be effective in the postponement of labor for 48 hours so that the patient can receive corticosteroid fetal lung maturation therapy. The most common risk factor observed in this group of patients with preterm labor was urinary tract infection.
Asunto(s)
Nifedipino/uso terapéutico , Trabajo de Parto Prematuro/tratamiento farmacológico , Tocolíticos/uso terapéutico , Adolescente , Adulto , Dexametasona/farmacología , Dexametasona/uso terapéutico , Esquema de Medicación , Evaluación de Medicamentos , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Madurez de los Órganos Fetales/efectos de los fármacos , Edad Gestacional , Hospitales Urbanos , Humanos , Pulmón/efectos de los fármacos , Pulmón/embriología , Nifedipino/administración & dosificación , Trabajo de Parto Prematuro/epidemiología , Paridad , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Puerto Rico/epidemiología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Tocolíticos/administración & dosificación , Infecciones Urinarias/epidemiología , Adulto JovenRESUMEN
Determinar las modificaciones en Doppler de las arterias uterinas, umbilical y cerebral media fetal en embarazadas con amenaza de parto pretérmino tratada con nifedipina oral como tocolítico. Se seleccionaron 50 pacientes con diagnóstico de amenaza de parto pretérmino. Las pacientes recibieron nifedipina a una dosis inicial de 30 mg sublinguales seguida por una dosis oral de 20 mg dos a cuatro veces al día. La dosis máxima fue de 120 mg cada 24 horas. Se midieron los índices de pulsatilidad, índice de resistencia y relación de flujo sistólico / diastólica de las arterias uterinas, umbilical y cerebral media fetal antes y después del tratamiento. Servicio de Ginecología y Obstetricia. Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. La edad materna promedio al inicio del estudio fue de 26,9 ± 6,9 años y la edad gestacional promedio fue de 30,3 ± 2,6 semanas. La duración promedio del tratamiento fue de 4,8 ± 1,5 días. No se encontraron diferencias estadísticamente significativas en los valores promedio de la frecuencia cardíaca materna y fetal, presión arterial sistólica, presión arterial diastólica antes y después del tratamiento con nifedipina oral (P = ns). No se encontraron diferencias significativas en los índices de pulsatilidad, índice de resistencia y relación de flujo sistólico / diastólica en las arterias uterinas, umbilical y cerebral media fetal antes y después del tratamiento con nifedipina oral (P = ns). El uso de nifedipina oral como tocolítico no produce modificaciones significativas en las mediciones Doppler de las arterias uterinas, umbilical y cerebral media fetal en embarazadas con amenaza de parto pretérmino
To determine modifications of Doppler of uterine, umbilical and fetal middle cerebral arteries in pregnant women with threatened pre-term labor treated with oral nifedipine as tocolytic agent. Fifty patients with diagnosis of threatened pre-term labor were selected. Patients received an initial dose of 30 mg of sub lingual nifedipine followed by an oral dose of 20 mg twice to four times a day. A maximum dosage was of 120 mg each 24 hours. The pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries were measured before treatment and after treatment. Servicio de Ginecologia y Obstetricia. Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. Maternal mean age at beginning of study was 26.9 ± 6.9 years-old and gestational mean age was 30.3 ± 2.6 weeks. Mean duration of treatment was 4.8 ± 1.5 days. There were not found significant differences in mean values of maternal and fetal heart rate, systolic blood pressure and diastolic blood pressure before and after treatment with oral nifedipine (p = ns). There were not found significant differences in pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries before and after treatment (p = ns). The use of oral nifedipine as tocolytic agent did not produce significant modifications in Doppler measurements of uterine, umbilical and fetal middle cerebral arteries in pregnant women with threatened pre-term labor
Asunto(s)
Embarazo , Ecocardiografía Doppler/métodos , Flujo Sanguíneo Regional , Nifedipino/uso terapéutico , Trabajo de Parto Prematuro/patología , ObstetriciaRESUMEN
Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson s Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (chi2 = 24.26 for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (chi2 =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (chi2 = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (chi2 = 20.00, p < 0.001), attractive (chi2 = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (chi2 = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.
Asunto(s)
Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Diuréticos/uso terapéutico , Etiquetado de Medicamentos , Enalapril/uso terapéutico , Hidroclorotiazida/uso terapéutico , Nifedipino/uso terapéutico , Folletos , Educación del Paciente como Asunto , Prioridad del Paciente , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Diuréticos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Calcium ion participates in the regulation of neural transmission and the presynaptic release of neurotransmitters. It is also involved in epileptic events, cardiac arrhythmias and abnormal conduction of stimuli. The purpose of the present study was to evaluate the effects of nifedipine, a calcium channel blocker, on epileptic seizures and on reperfusion arrhythmias in rats prone to audiogenic epileptic seizures (Wistar audiogenic rats, WAR) and in normal Wistar rats (N = 6/group). The seizure severity index was applied after an intraperitoneal injection of 20 or 40 mg/kg nifedipine (N20 and N40 groups, respectively). The Langendorff technique was used to analyze cardiac function, as well as the incidence and severity of the reperfusion arrhythmias after ligature and release of the left coronary artery in rats treated or not with nifedipine. We found that nifedipine treatment decreased seizure severity (0.94 ± 0.02 for WAR; 0.70 ± 0.10 for WAR + N20; 0.47 ± 0.08 for WAR + N40) and increased the latent period (13 ± 2 s for WAR; 35 ± 10 s for WAR + N20; 48 ± 7 s for WAR + N40) for the development of seizures in WAR. Furthermore, the incidence and severity of the reperfusion arrhythmias were lower in WAR and normal Wistar rats injected with nifedipine. In WAR, these effects were mediated, at least in part, by a decrease in heart rate. Thus, our results indicate that nifedipine may be considered to be a potential adjuvant drug for epilepsy treatment, especially in those cases associated with cardiac rhythm abnormalities.
Asunto(s)
Animales , Masculino , Ratas , Antiarrítmicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Arritmias Cardíacas/tratamiento farmacológico , Nifedipino/uso terapéutico , Convulsiones/tratamiento farmacológico , Estimulación Acústica , Modelos Animales de Enfermedad , Electrocardiografía , Epilepsia Refleja , Ratas Wistar , Índice de Severidad de la EnfermedadRESUMEN
Calcium ion participates in the regulation of neural transmission and the presynaptic release of neurotransmitters. It is also involved in epileptic events, cardiac arrhythmias and abnormal conduction of stimuli. The purpose of the present study was to evaluate the effects of nifedipine, a calcium channel blocker, on epileptic seizures and on reperfusion arrhythmias in rats prone to audiogenic epileptic seizures (Wistar audiogenic rats, WAR) and in normal Wistar rats (N = 6/group). The seizure severity index was applied after an intraperitoneal injection of 20 or 40 mg/kg nifedipine (N20 and N40 groups, respectively). The Langendorff technique was used to analyze cardiac function, as well as the incidence and severity of the reperfusion arrhythmias after ligature and release of the left coronary artery in rats treated or not with nifedipine. We found that nifedipine treatment decreased seizure severity (0.94 ± 0.02 for WAR; 0.70 ± 0.10 for WAR + N20; 0.47 ± 0.08 for WAR + N40) and increased the latent period (13 ± 2 s for WAR; 35 ± 10 s for WAR + N20; 48 ± 7 s for WAR + N40) for the development of seizures in WAR. Furthermore, the incidence and severity of the reperfusion arrhythmias were lower in WAR and normal Wistar rats injected with nifedipine. In WAR, these effects were mediated, at least in part, by a decrease in heart rate. Thus, our results indicate that nifedipine may be considered to be a potential adjuvant drug for epilepsy treatment, especially in those cases associated with cardiac rhythm abnormalities.
Asunto(s)
Antiarrítmicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Arritmias Cardíacas/tratamiento farmacológico , Nifedipino/uso terapéutico , Convulsiones/tratamiento farmacológico , Estimulación Acústica , Animales , Modelos Animales de Enfermedad , Electrocardiografía , Epilepsia Refleja , Masculino , Ratas , Ratas Wistar , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: To compare the efficacy of nifedipine and fenoterol in the management of threatened preterm labor (TPL). METHODS: A randomized and multicenter study assessing the tocolytic effect of nifedipine versus fenoterol in patients admitted to the participating maternity units with a diagnosis of TPL and a cost-savings study for economic assessment. For a power of 80% and an α error equal to 0.05, 132 consecutive patients were recruited during the study period; 66 patients were assigned to each group. A χ(2) analysis and a mean differences test were performed according to variable types and survival curves per intention-to-treat. RESULTS: Demographics were similar in both groups. The latency period was similar in both groups (26.7 vs. 25.6; p = 0.3). There were no differences in the results obtained. Nifedipine failed more frequently to obtain tocolysis when used as a first-line agent (80 vs. 90%, p = 0.0001). The group treated with fenoterol showed more drug adverse events (57.8 vs. 19.0%, p = 0.0001). The economic assessment did not evidence a significant difference in terms of cost savings between groups treated with either drug. CONCLUSION: The present study failed to demonstrate either clinical or economic superiority of any of the two drugs used in TPL management. The highest failure percentage of nifedipine when used as a first-line agent should encourage further research.
Asunto(s)
Fenoterol/uso terapéutico , Nifedipino/uso terapéutico , Trabajo de Parto Prematuro/tratamiento farmacológico , Tocolíticos/uso terapéutico , Adolescente , Adulto , Costos y Análisis de Costo , Femenino , Humanos , Embarazo , Tocólisis/economía , Insuficiencia del TratamientoRESUMEN
Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson's Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (ϲ = 24.26for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (ϲ =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (ϲ = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (ϲ = 20.00, p < 0.001), attractive (ϲ = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (ϲ = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.
Las monografías de medicamentos estandarizadas se han considerado deficientes a la hora de proporcionar información de manera suficientemente simple para que el paciente pueda entenderlas. El objetivo de este estudio fue disenar prospectos con información sobre la hidroclorotiazida, la nifedipina y el analapril con contenidos indicados como relevantes por los pacientes, y evaluarlos en comparación con las monografías estandarizadas de medicamentos (MEM). El prospecto de información para el paciente (PIP) fue disenado de modo que apareciera información sobre el nombre del medicamento, su uso, modo de operar, manera de tomarse, efectos secundarios comunes, almacenamiento, qué hacer en caso de perder una dosis, cosas que deben evitarse, y cuando debe contactarse el médico. Se evaluó la adecuación por parte de 10 farmacéuticos practicantes. Para cada medicamento, se reclutaron 40 pacientes, a 20 de los cuales se les dio monografías (MEM), en tanto que a 20 se les ofreció prospectos (PIP). El conocimiento de cada participante se examinó antes y después de la exposición a MEM o PIP, así como la opinión en cuanto a facilidad de lectura y grado de atracción, usando el análisis del Chi-cuadrado de Pearson. Los resultados mostraron que tanto MEM como PIP mejoraron el conocimiento sobre los efectos secundarios comunes, cuando se hacía una comparación con las respuestas antes de la exposición (ϲ = 24.26para MEMy 27.64para PIP, p < 0.001) sin diferencia entre los grupos. Los encuestados que recibieron prospectos pudieron recordar mejor las "cosas a evitar" luego de la exposición a PIP (ϲ =10.85, p < 0.001). Después de la exposición a MEM o PIP, los encuestados con PIP tenían mayor conciencia en cuanto a cuando contactar a un médico, en comparación con el grupo MEM (ϲ = 8.41, p < 0.01). Cuando se les comparó con el grupo MEM, los encuestados que recibieron PIP mostraron por una parte mayor probabilidad de indicar que PIP era más fácil de leer (ϲ = 20.00, p < 0.001) y atractivo (ϲ = 12.45, p < 0.001), y por otra, una mayor tendencia a recomendar la distribución de su material de lectura a otros pacientes (ϲ = 22.11, p < 0.001). Se llegó a la conclusión de que es beneficioso disenar prospectos que simplifiquen el lenguajey la información médica contenida en las monografias estándar del medicamento, incluyendo una mejor comprensión de las precauciones a tomar mientras se está bajo medicación, y sobre cuándo consultar al médico.