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Bisphosphonates and Esophageal Cancer.29
Dronedarone Safety.31
PRIMARY CARE Exemestane for Breast Cancer Prevention.30
Fluconazole in Pregnancy.30
Methylene Blue and Linezolid Warnings.32
DRUG ALERTS Reference Guide.32
Statins and Diabetes .31
Ticagrelor Approval .29
Valproate and Cognitive Development.31
will be available in 90-mg tablets and should Ticagrelor Approved
be initiated with a 180-mg oral loading dose, The FDA has approved a new oral antiplatelet agent, ticagrelor (Brilinta), to reduce the rate of FDA approves new medicine Brilinta (ticagrelor) for use myocardial infarction (MI) and cardiovascular in the US [press release]. Wilmington, Del.: AstraZeneca;July 20, 2011.
death in adults with acute coronary syndromes, Drug Trade Names: clopidogrel—Plavix;
such as unstable angina, non-ST-elevation MI, and lovastatin—Altoprev, Mevacor; simvastatin—Zocor;
ST-elevation MI. Ticagrelor has been shown to ticagrelor—Brilinta
reduce the rate of a combined endpoint of cardio-vascular death, MI, and stroke compared with Bisphosphonates and Esophageal Cancer
clopidogrel, although there was not a significant Esophagitis and other adverse esophageal events difference in the rate of strokes. In patients who have been reported with use of oral bisphospho- underwent percutaneous coronary intervention, nates, particularly in patients who do not follow ticagrelor reduced the rate of stent thrombosis. the administration instructions.1 Findings from Like other antiplatelet agents, ticagrelor can studies evaluating esophageal cancer risk have cause significant, sometimes fatal, bleeding. In been inconsistent, and the FDA is conducting a the large head-to-head PLATO trial comparing review to determine if the association exists. At ticagrelor plus aspirin with clopidogrel plus this time, the FDA considers the data insufficient aspirin, there was no significant difference in to recommend endoscopic screening for patients major bleeding events between ticagrelor and with esophageal symptoms. Patients taking clopidogrel. Fatal and life-threatening bleeding alendronate, risedronate, ibandronate, etidronate, events also did not differ. However, noncoronary or tiludronate should be reminded to follow the artery bypass graft bleeding and dyspnea were label instructions carefully, particularly in regard to water and food intake and remaining upright after aspirin use impacts ticagrelor efficacy, and ingestion. Failure to follow these instructions could doses >100 mg/day reduced its effectiveness.
increase the risk of esophageal adverse reactions.2 Ticagrelor use is contraindicated in patients 1Oral osteoporosis drugs (bisphosphonates): drug with severe hepatic impairment, and it has not safety communication – potential increased risk of been studied in patients with moderate impair- esophageal cancer. FDA MedWatch Alert: Available at www.fda.gov/Safety/MedWatch.
ment. Because ticagrelor is metabolized via 2Facts and Comparisons eAnswers: Available at simvastatin and lovastatin, also metabolized Drug Trade Names: alendronate—Fosamax;
via that pathway, should be avoided. Ticagrelor etidronate—Didronel; ibandronate—Boniva;
risedronate—Actonel, Atelvia; tiludronate—Skelid
Primary Care Drug Alerts® (ISSN 1061-0359) is published monthly by M.J. Powers & Co. Publishers, 65 Madison Ave.,
Morristown, NJ 07960. Telephone 973-898-1200. E-mail: [email protected]. Periodical-class postage is paid at Morristown,
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