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Prescription Practice: Progress in Medicine
PRESCRIPTION PRACTICE
PROGRESS in MEDICINE Acetyldigitoxin in Treatment of Heart Failure
Clinical experiences with 72 patients, with congestive heart failure or atrial fibrillation or flutter, or both, with a rapid ventricular rate, who were treated with acetyldigitoxin (Acylanid), are reported by Drs. Hennan Gold and S. Benet, New Engl. J. Med., 256, 536 (Mar. 21, 1957). Various etiologic types of heart disease were included in the series of patients. The physicians found that adequate digitalization was obtained in most cases by oral administration of 1.6 to 2.0 mg. of acetyldigitoxin given in 24 hours. A large initial dose of 1.0 to 1.2 mg., followed in six to eight hours by 0.4 to 0.6 mg., is an effective method of digitalization. Somewhat larger doses, 2.0 to 2.6 mg., were required when the multiple-dose schedule was used. The maintenance dose ranged from 0.025 mg. to 0.33 mg. per day; most patients required 0.10 to 0.15 mg. daily. Nausea and vomiting occurred as early symptoms of toxicity. Toxic signs, when present, subsided promptly in most patients, usually within 24 to 72 h~urs. As with other digitalis preparations, individualization of the digitalizing and maintenance doses of acetyldigitoxin is essential for maximum therapeutic results and avoidance of toxicity. In another report by Dr. P. J. Sanazaro, J. Am. Med. Assoc., 164, 743 (June 15, 1957), the oral digitalizing dose of acetyldigitoxin (Acylanid), determined in 31 ambulatory patients, ranged from 0.8 mg. in 24 hours to 3.2 n1g. in 120 hours or more and averaged 1.6 to 2.0 mg. in 48 to 72 hours. The drug was given in doses of 0.2 mg. three or four times a day. The maintenance dose, determined in 3g patients, ranged fr(lm 0.05 to 0.2 mg. per day. Aspirin Solutions-Stability
Studies with aqueous dispersions of aspirin show that the rate of hydrolysis is so high that they are unsatisfactory as dosage forms when an unhydrolyzed product is desired. The report by A. E. Bowey, Pharm. J. New Zealand, 19, 11 (May 10, 1957), shows also that potassium citrate (80 gr./2 fl. oz.) is the best stabilizer tested (21% hydrolysis in 4 days, 25% in 7 days), calcium hydroxide is poorest, acetates and phosphates are intennediate, but the phosphate mixtures are slightly turbid. Addition of citric acid (equivalent to 60 minims of lemon syrup per fl. oz.) to potassium
498
citrate-aspirin solutions did not increase hydrolysis, but likelihood of causing precipitation is a factor against its use for routine dispensing. Dermatological Therapy
A review of recent advances in dermatological therapy is given by Drs. G. M. Lewis and D. Torre, Am. J. Med. Sci., 233, 573(May 1957). The physicians note that in syphilis, use of penicillin alone has superseded combination treatmentincluding arsenic and bismuth compounds, and give a dosege schedule with procaine penicillin G in oil with 2% aluminum monostearate. Use of isoniazid, orally, has revolutionized the treatment of tuberculosis of the skin. Use of 8-methoxypsoralen (methoxsalen NND, Oxsoralin), orally and topically, gave encouraging results in the treatment of vitiligo, and led to claims for its "protective" action permitting sun-sensitive individuals to obtain quick sun tans. Later reports were more conservative and the clinician's conclusion is that methoxsalen "does not have a primary protective action but rather augments all cutaneous responses." Antimalarial drugs, such as quinacrine and chloroquine, are now favored in the treatment of lupus erythematosus. In fungal diseases, diamthazole di-Hel (Asterol) tincture or ointment, undecylenic and propionic acids in ointment and powder, and nystatin (in moniliasis cases) are additions to the therapy of superficial mycoses which seem destined to remain. The effects of tranquilizing drugs in dermatoses associated with mental states are mentioned, and the uses of corticoid drugs, topically and systemically, and therapy with antibiotics and enzymes are mentioned. The physicians note that "many timehonored modalities such as Roentgen rays and drugs such as salicylic acid are still useful in the therapy of skin disorders." Drugs Other Than Anticoagulants in Arteriosclerotic Heart Disease
In a review of the causes and treatment of arteriosclerotic heart disease, Dr. C. F. Wilkinson, Jr., J. Am. Med. Assoc., 163, 927(Mar. 16, 1957), notes that, "Atherogenesis can be pictured as a process in which an inherited defect of arterial structure permits the development of atherosclerotic plaques under the influence of secondary factors such
JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION
as hypertension, renal disease, and certain hormone imbalances. Drugs that alter the concentration of the blood lipids and lipoproteins have been studied as to their influence on this process; none of those tried by the authors, including sitosterol, have given convincing results. Data from three representative patients during periods longer than two years showed that normal variations of blood cholesterol values exceeded the changes attributable to sitosterol and that observations over shorter periods must give misleading results." Dr. Wilkinson reports that in about 75% of his patients with familial hyperlipemia, the condition is controlled by a fat -free breakfast, a fat-free lunch, and no restriction on fat in the evening meal. He concludes: "The treatment of atherosclerosis, however, remains unsettled except that the patient's weight must be controlled and that secondary aggravating causes must be diligently searched for." Radioisotopes in Ophthalmology
A review of diagnostic and therapeutic applications of radioisotopes in opthalmology, by E. B. Dunphy, Bull. N. y. Acad. Med., 33 , 310(May 1957), is concluded as follows: "The question may now be asked: of how much value have they really been in our field of medicine? In answer, I think we can say that in the realm of ocular physiology they have been invaluable. Because of them, we now know fairly accurately the rate of aqueous formation, and the old theory of the aqueous being merely a stagnant dialysate has given way to the newer concept of secretion and flow . In the field of intraocular tumor detection, p32 has proved a definite aid to our clinical judgment, provided certain limitations are recognized. I t would be premature to say that it is infallible even in the anterior lesions until more cases have been studied. Jt is reasonable to expect that, with the development of better instrumentation, the present difficulties of reaching posterior lesions will be overcome. It is possible that other isotopes may be found to be equally good or even better. In the field of therapy, with the exception of the beta applicators, the radioisotopes have been disappointing so far, but many unexplored avenues exist and the next few years may bring results undreamed of at the present time. "
PROGRESS in MEDICINE Acetyldigitoxin in Treatment of Heart Failure
Clinical experiences with 72 patients, with congestive heart failure or atrial fibrillation or flutter, or both, with a rapid ventricular rate, who were treated with acetyldigitoxin (Acylanid), are reported by Drs. Hennan Gold and S. Benet, New Engl. J. Med., 256, 536 (Mar. 21, 1957). Various etiologic types of heart disease were included in the series of patients. The physicians found that adequate digitalization was obtained in most cases by oral administration of 1.6 to 2.0 mg. of acetyldigitoxin given in 24 hours. A large initial dose of 1.0 to 1.2 mg., followed in six to eight hours by 0.4 to 0.6 mg., is an effective method of digitalization. Somewhat larger doses, 2.0 to 2.6 mg., were required when the multiple-dose schedule was used. The maintenance dose ranged from 0.025 mg. to 0.33 mg. per day; most patients required 0.10 to 0.15 mg. daily. Nausea and vomiting occurred as early symptoms of toxicity. Toxic signs, when present, subsided promptly in most patients, usually within 24 to 72 h~urs. As with other digitalis preparations, individualization of the digitalizing and maintenance doses of acetyldigitoxin is essential for maximum therapeutic results and avoidance of toxicity. In another report by Dr. P. J. Sanazaro, J. Am. Med. Assoc., 164, 743 (June 15, 1957), the oral digitalizing dose of acetyldigitoxin (Acylanid), determined in 31 ambulatory patients, ranged from 0.8 mg. in 24 hours to 3.2 n1g. in 120 hours or more and averaged 1.6 to 2.0 mg. in 48 to 72 hours. The drug was given in doses of 0.2 mg. three or four times a day. The maintenance dose, determined in 3g patients, ranged fr(lm 0.05 to 0.2 mg. per day. Aspirin Solutions-Stability
Studies with aqueous dispersions of aspirin show that the rate of hydrolysis is so high that they are unsatisfactory as dosage forms when an unhydrolyzed product is desired. The report by A. E. Bowey, Pharm. J. New Zealand, 19, 11 (May 10, 1957), shows also that potassium citrate (80 gr./2 fl. oz.) is the best stabilizer tested (21% hydrolysis in 4 days, 25% in 7 days), calcium hydroxide is poorest, acetates and phosphates are intennediate, but the phosphate mixtures are slightly turbid. Addition of citric acid (equivalent to 60 minims of lemon syrup per fl. oz.) to potassium
498
citrate-aspirin solutions did not increase hydrolysis, but likelihood of causing precipitation is a factor against its use for routine dispensing. Dermatological Therapy
A review of recent advances in dermatological therapy is given by Drs. G. M. Lewis and D. Torre, Am. J. Med. Sci., 233, 573(May 1957). The physicians note that in syphilis, use of penicillin alone has superseded combination treatmentincluding arsenic and bismuth compounds, and give a dosege schedule with procaine penicillin G in oil with 2% aluminum monostearate. Use of isoniazid, orally, has revolutionized the treatment of tuberculosis of the skin. Use of 8-methoxypsoralen (methoxsalen NND, Oxsoralin), orally and topically, gave encouraging results in the treatment of vitiligo, and led to claims for its "protective" action permitting sun-sensitive individuals to obtain quick sun tans. Later reports were more conservative and the clinician's conclusion is that methoxsalen "does not have a primary protective action but rather augments all cutaneous responses." Antimalarial drugs, such as quinacrine and chloroquine, are now favored in the treatment of lupus erythematosus. In fungal diseases, diamthazole di-Hel (Asterol) tincture or ointment, undecylenic and propionic acids in ointment and powder, and nystatin (in moniliasis cases) are additions to the therapy of superficial mycoses which seem destined to remain. The effects of tranquilizing drugs in dermatoses associated with mental states are mentioned, and the uses of corticoid drugs, topically and systemically, and therapy with antibiotics and enzymes are mentioned. The physicians note that "many timehonored modalities such as Roentgen rays and drugs such as salicylic acid are still useful in the therapy of skin disorders." Drugs Other Than Anticoagulants in Arteriosclerotic Heart Disease
In a review of the causes and treatment of arteriosclerotic heart disease, Dr. C. F. Wilkinson, Jr., J. Am. Med. Assoc., 163, 927(Mar. 16, 1957), notes that, "Atherogenesis can be pictured as a process in which an inherited defect of arterial structure permits the development of atherosclerotic plaques under the influence of secondary factors such
JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION
as hypertension, renal disease, and certain hormone imbalances. Drugs that alter the concentration of the blood lipids and lipoproteins have been studied as to their influence on this process; none of those tried by the authors, including sitosterol, have given convincing results. Data from three representative patients during periods longer than two years showed that normal variations of blood cholesterol values exceeded the changes attributable to sitosterol and that observations over shorter periods must give misleading results." Dr. Wilkinson reports that in about 75% of his patients with familial hyperlipemia, the condition is controlled by a fat -free breakfast, a fat-free lunch, and no restriction on fat in the evening meal. He concludes: "The treatment of atherosclerosis, however, remains unsettled except that the patient's weight must be controlled and that secondary aggravating causes must be diligently searched for." Radioisotopes in Ophthalmology
A review of diagnostic and therapeutic applications of radioisotopes in opthalmology, by E. B. Dunphy, Bull. N. y. Acad. Med., 33 , 310(May 1957), is concluded as follows: "The question may now be asked: of how much value have they really been in our field of medicine? In answer, I think we can say that in the realm of ocular physiology they have been invaluable. Because of them, we now know fairly accurately the rate of aqueous formation, and the old theory of the aqueous being merely a stagnant dialysate has given way to the newer concept of secretion and flow . In the field of intraocular tumor detection, p32 has proved a definite aid to our clinical judgment, provided certain limitations are recognized. I t would be premature to say that it is infallible even in the anterior lesions until more cases have been studied. Jt is reasonable to expect that, with the development of better instrumentation, the present difficulties of reaching posterior lesions will be overcome. It is possible that other isotopes may be found to be equally good or even better. In the field of therapy, with the exception of the beta applicators, the radioisotopes have been disappointing so far, but many unexplored avenues exist and the next few years may bring results undreamed of at the present time. "