- Email: [email protected]
Re: Donnelley and Walsh letter to the editor
Re: The Use of To@al Itt$irti Anesthetic tn Red&e Injection Pain in Childm
Re:Donnellcyan4fwalsh La?tkkrtothemti To the Editor: I would like to take the opportunity to respond to the Letter to the Editor by Sinead Donnelly, MB, and T. De&n Walsh, MSc (Jotlrnal Pain !$mptom Manage 10(3):182-183). The Donnelly-Walsh letter discusses a case report on the use of megestrol acetate fol appetite stimulation in advanced cancer. The authors conclude with a weekly cost comparison of 800 mg/day of megestrol acetate and quoted prices of $212.00 per week for Megace (megestrol acetate) tablets, $372.70 per week for Megace (megestrol acetate) Oral Suspension, and 1117.80 per week for a daily BO mp dose of generic megestrol acetate tablets ($178.00 per week for 800 mg/day dose). I would like to bring to your attention that the price of SS72.00 per week for the Megace Oral Suspension printed in the Letter to the Editor is grossly incorrect. The weekly cost of BOO mg/day of Megace Oral Suspension is 860.55, that of Megace tablets is 5174.72. and the cci)t of megestrol acetate tablets (generic) range from $107.10 to $149.73. This information is based on the 1995 Drug Topit RED BOOK Average Wholesale Price (AWP) for a bottle .,f 240 mL Megace Oral Suspension, a bottle of 100 Megace 40 mg table& and a bottle of 100 megestrol acetate (generic) 40 mg tablets. Megace Oral Suspension contains 40 mg of micronized megestrol acetate per mL (BOO mg/20 mL); is much more convenient to takr than twenty 40 mg megestrol acetate tablets, and is by far the least expensive form. We thank you for your cooperation in this matter and hope that you will bring it to the attention of your subscribers. Daniels, MD Medical Information Bristol-Myers Squibb Oncology Princeton. New Jersey
Vor 12 No. 4 Oclobcr 19%
Lam
208
To the Fditor: With regard to “The Use of Topical Kefrigetant Anesthetic to Reduce Injection Pain in Children,” by Abbott and Fowler-Kerry uournal Pain Symptom Manage lC(B):584-590). although the study was well thought out, we would refute the overall conclusion made that refrigerant anesthetic sprays should be used to reduce pain at injection sites in children. The results of the study indicated that both the +rigerant spray and the placebo were equally effective. Refrigerant topical substances, usually volatile, cause an anaesthetic effect by reducing the temperature of the skin. IL has been shown that cooling the skin at an injection site with either spray or ice will result in decreased pain.’ The use of the placebo spray, compressed air with freon, would also result in skin cooling. This could account for the negligible difference between those who had refrigerant spray and those who received placebo. This study supports the use of a topical spmy to reduce InJection pain in children. The use of a refrigerant spray, however, is not necessarily indicated.
Karen Broadley Consultant and Julie Ling. Research Nune Palliative Care The Royal Marsden NHS Trust London, United Kingdom PII so8ss-392q%pol4l3-
Michelle Director,
Ptl solB5-392q%)oo141-9
Division
I. .i‘rawll, J. Factors affecting JIGMA 1955;158:%%-371.
pain of injection.
Re:Donnellcyan4fwalsh La?tkkrtothemti To the Editor: I would like to take the opportunity to respond to the Letter to the Editor by Sinead Donnelly, MB, and T. De&n Walsh, MSc (Jotlrnal Pain !$mptom Manage 10(3):182-183). The Donnelly-Walsh letter discusses a case report on the use of megestrol acetate fol appetite stimulation in advanced cancer. The authors conclude with a weekly cost comparison of 800 mg/day of megestrol acetate and quoted prices of $212.00 per week for Megace (megestrol acetate) tablets, $372.70 per week for Megace (megestrol acetate) Oral Suspension, and 1117.80 per week for a daily BO mp dose of generic megestrol acetate tablets ($178.00 per week for 800 mg/day dose). I would like to bring to your attention that the price of SS72.00 per week for the Megace Oral Suspension printed in the Letter to the Editor is grossly incorrect. The weekly cost of BOO mg/day of Megace Oral Suspension is 860.55, that of Megace tablets is 5174.72. and the cci)t of megestrol acetate tablets (generic) range from $107.10 to $149.73. This information is based on the 1995 Drug Topit RED BOOK Average Wholesale Price (AWP) for a bottle .,f 240 mL Megace Oral Suspension, a bottle of 100 Megace 40 mg table& and a bottle of 100 megestrol acetate (generic) 40 mg tablets. Megace Oral Suspension contains 40 mg of micronized megestrol acetate per mL (BOO mg/20 mL); is much more convenient to takr than twenty 40 mg megestrol acetate tablets, and is by far the least expensive form. We thank you for your cooperation in this matter and hope that you will bring it to the attention of your subscribers. Daniels, MD Medical Information Bristol-Myers Squibb Oncology Princeton. New Jersey
Vor 12 No. 4 Oclobcr 19%
Lam
208
To the Fditor: With regard to “The Use of Topical Kefrigetant Anesthetic to Reduce Injection Pain in Children,” by Abbott and Fowler-Kerry uournal Pain Symptom Manage lC(B):584-590). although the study was well thought out, we would refute the overall conclusion made that refrigerant anesthetic sprays should be used to reduce pain at injection sites in children. The results of the study indicated that both the +rigerant spray and the placebo were equally effective. Refrigerant topical substances, usually volatile, cause an anaesthetic effect by reducing the temperature of the skin. IL has been shown that cooling the skin at an injection site with either spray or ice will result in decreased pain.’ The use of the placebo spray, compressed air with freon, would also result in skin cooling. This could account for the negligible difference between those who had refrigerant spray and those who received placebo. This study supports the use of a topical spmy to reduce InJection pain in children. The use of a refrigerant spray, however, is not necessarily indicated.
Karen Broadley Consultant and Julie Ling. Research Nune Palliative Care The Royal Marsden NHS Trust London, United Kingdom PII so8ss-392q%pol4l3-
Michelle Director,
Ptl solB5-392q%)oo141-9
Division
I. .i‘rawll, J. Factors affecting JIGMA 1955;158:%%-371.
pain of injection.