Generics: need for clinical concern?

[Clinical characteristic of factors and tools influencing the effectiveness and safety of local anesthesia in dentistry]

Dental health is one of the most important signs of life quality and depends on the level of health care organization. Recently the clinical odontology is intensively developing, including local anesthesia where constant searching of effective remedies and methods of suppression and treatment of pain is carried out. At the same time carrying out adequate local anesthesia has important practical value that is to some extent bound to massive visits of the patients to the clinics. One of the important factors in the solution of problems of effectiveness and safety of local anesthesia is knowledge of anatomy-topographical features of the structure of maxillofacial area as the irregular technique of local anesthesia which is carried out without features of the anatomical structure of jaws is the main reason for ineffective anesthesia. From the practical side, the special attention is paid to the patients having various accompanying diseases with negative treatment emotions that lead to the stress development, disorganization of work of functional systems of the organism, change of the mental state. However the basis of diagnostic process at dentist's consultation depends on the clinical thinking of the doctor which is bound to knowledge of medical psychology and psychoprophylaxis that needs to be applied in the daily practice. In particular clinical situations premedication methods are successfully used for carrying out adequate anesthesia for dental interventions. A wide range of ways and methods of the lower alveolar nerve blockade are used in dentistry, where the composite external and internal anatomy-topographical markers which are difficult to remember for the doctor are applied. It causes the need of carrying out further researches on the maximal simplification of technological and methodological features of mandibular anesthesia and its introduction into dental practice.

A retrospective analysis of drug-related problems documented in a national database

BACKGROUND

Numerous patients are subject to drug-related problems (DRPs) every day, resulting in sub-optimal therapy, suffering and decreased quality of life, as well as in high societal health care costs. Classifying DRPs is important for the development of counselling skills and for pharmaceutical care practice and research, including assessments of the value of pharmacists' clinical interventions. Pharmacy practitioners have also reported to become more attentive to patients' drug-related needs, when requested to document their clinical interventions. Several studies have been conducted on DRPs, but there is still a need for a more thorough knowledge about their nature and the reasons for their occurrence. To examine DRP characteristics and causes by retrospectively analysing data and patient case histories, as documented by pharmacy practitioners in the Swedish national DRP database.

SETTING

Community pharmacy based patient documentation, entered into the Swedish national DRP database.

METHOD

Documented DRPs, clinical interventions and patient data were retrospectively examined and analysed. Particular attention was paid to case history reports in free text fields. Only reports containing adequate information for analysis and actual, correctly categorised DRPs were included.

MAIN OUTCOME MEASURE

Subdivided DRP characteristics and causes.

RESULTS

Both similarities and differences between DRP subclasses of prescription patients (n = 5,571) and OTC drug consumers (n = 2,894) were observed. Most DRP categories could be subdivided into at least three subclasses, according to their characteristics. Causes of DRPs could be extracted from free text field reports in four prescription DRP categories and three OTC DRP categories. Uncertainty about the aim of the drug was commonly characterised by a lack of knowledge about the indication in prescription patients and in an inappropriate drug selection in OTC drug consumers. A switch from a brand-name drug to a generic drug or from one generic to another was the cause in half of the therapy failures, which in turn was a frequent reason for overuse of drug.

CONCLUSION

The study demonstrates the multi-facetted drug-related problems in patients and confirms the importance of attention by pharmacy practitioners for the detection of and intervention for DRPs.

Generics and cost-effective prescribing in Belgium: does bioequivalence always translate in therapeutic equivalence?

As many other countries, Belgium has a policy to promote the use of generic pharmaceutical products. In order to protect consumers, these generic products must be demonstrated to be essentially similar to the previously approved product, typically an innovator product. The therapeutic equivalence of a generic and an innovator product is most commonly based on the demonstration of bioequivalence, i.e. clinically insignificant differences in the rate and extent of drug absorption usually assessed from pharmacokinetic measurements, in a normal and healthy population. This article reviews the bioequivalence requirements for generic products and examines whether bioequivalence always adequately substantiates therapeutic equivalence and interchangeability. Clinical practice has identified a number of drug classes for which generic substitution should be approached with caution. Current bioequivalence requirements are based on a measure of average bioequivalence. There are fears that use of this measure may be inappropriate in the case of a drug with a narrow therapeutic range or high intrasubject or intersubject variability. Under these circumstances, measures of individual and population bioequivalence are proposed to be more accurate than measures of average bioequivalence. Bioequivalence issues are discussed together more general concerns about generic drug substitution, such as differences in product and packaging appearance and differences in excipients.