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Drug class preferred antiincontinence oxybutynin ditropan ; # oxybutynin xl ditropan agents xl ; oxybutynin transdermal oxytrol ; flavoxate urispas ; # tolterodine la detrol la ; non-preferred criteria tolterodine detrol ; pa criteria: all of the preferred agents in this category must be tried before a non-preferred agent will be authorized, unless one of the exceptions on the pa form is present. Border 1 alt preview by thumbshots detrol , detrol side effects , detrol antidepressants however, the potential effect of tolterodine on the. Cholesterol-Absorption Inhibitors Vytorin Zetia Methylin ER Methylphenidate Methylphenidate SR Ritalin LA Adderall XR Concerta Focalin Focalin XR Generic agents considered "first-line" when appropriate. SEDATIVE HYPNOTICS, NON-BARBITURATES Temazepam Lunesta * Generics should be considered "first-line" when appropriate. Meglitinides Starlix Sulfonylureas, 2nd Generation Glipizide Glipizide ER Glyburide Glyburide Micronized Thiazolidinediones Actos Avandia BIPHOSPHONATES OSTEOPOROSIS Fosamax ANTISPASMODICS Drtrol LA Enablex Oxybutynin Oxytrol Sanctura Vesicare. The Group has planned to investigate, as the primary indication, the potential of PSD 506 in the treatment of urge urinary incontinence UUI ; due to overactive bladder, with its utility in BPH patients as a secondary indication. Wood Mackenzie believes that the Group has a well-defined clinical plan, with appropriate costs allocated to the planned clinical trials. Wood Mackenzie understands that the Group has already agreed three clinical trials with Roche for PSD 506, which retains options at the end of Phase IIa or Phase IIb studies ; to opt-in to the development of the programme. Indeed, Roche and the Group are working close together in partnership in the initial clinical development programme for this product. Competitive Position Urge urinary incontinence Anti-cholinergic or antimuscarinic drugs, which inhibit contraction and increase the capacity of the bladder, are established for the treatment of UUI. Wood Mackenzie understands that the market is heavily genericised with traditional anti-cholinergic type products, but the market growth in recent years has been driven by branded extended release formulations, principally Pfizer's Detroll LA tolterodine ; and J&J Sanofi-Aventis's Ditropan XL oxybutynin ; , which are both dosed once daily. As there is little efficacy difference between the current available products, the incidence of side-effects is the main competitive issue, induced by the fact that these drugs do not target specifically the M2 and M3 muscarinic receptors of the bladder. Indeed, Wood Mackenzie believes that Pfizer's promotional campaign focuses on the decreased incidence of dry mouth associated with Detrol. In Wood Mackenzie's view, further competition comes from Watson Pharmaceuticals' transdermal oxybutynin product, Oxytrol a transdermal product that may offer the benefit of increased patient compliance, considering the extensive use of these products in elderly populations. Wood Mackenzie believes that the competitive nature of this market has recently increased with the approval of Novartis' M3-selective antimuscarinic, Enablex Emselex darifenacin hydrobromide ; in the US and Europe in Q4 2004. Yamanouchi's M3-selective antimuscarinic, Vesicare solifenacin succinate ; is also launched in Europe and has been recently approved in the US November 2004 ; . Both Enablex and Vesicare were originally designed to be more bladder selective and therefore have fewer systemic side effects than the older products such as tolterodine and oxybutynin. Nevertheless, in large clinical trials, Wood Mackenzie understands that these drugs have failed to demonstrate a significant improvement in side-effects such as constipation and dry mouth that have been associated with the older products. Enablex has, however, shown an improved profile in terms of cognitive and cardiac side-effects, which Novartis is emphasising in its promotion of the product. Other products such as Trospium Sanctura trospium chloride ; from Indevus Pliva are also available, the marketing of which is focused on its safety profile, including a lack of interactions with drugs metabolised along the cytochrome P450 pathway note that the product label for Vesicare, De6rol LA and Ditropan XL recommends a reduced dose for patients taking drugs that are CYP3A4 inhibitors ; . Schwarz is also developing the "me too" tolterodine product fesoterodine, which the Company is claiming is potentially a more selective treatment for UUI than oxybutynin. However, Wood Mackenzie believes that these claims have been based on pre-clinical studies, which indicated that fesoterodine is more selective than oxybutynin for muscarinic M3 receptors. The clinical relevance of fesoterodine's apparent selectivity on side effects such as dry mouth has still to be established. In Wood Mackenzie's view, the market will continue to be dominated by oxybutynin and tolterodine products with no novel products targeting alternative targets set to enter the market through 2008. These novel targets under investigation for UUI e.g. Phase II candidates include Icos' vanilliox compound resiniferatoxin and Kyowa Hakko's afferent C fibre inhibitor KW-7158. Wood Mackenzie understands, however, that Barr is developing an oxybutynin ring and Sepracor is also developing a single isomer formulation of oxybutynin S-oxybutynin ; . Interestingly, the Japanese market is less well developed for UUI products neither Detroo nor Ditropan XL are yet available in that market. 46.
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2. List all medication: a. Include prescription and over the counter medications such as vitamins, minerals and herbs. b. Include the reason and the how often you take them. Many medicines have multiple purposes. Don't assume "he she knows" the reason you take each medicine. c. Don't rely on others to remember this information for you. What if the other person is not available, in an accident or in the hospital? Then what? d. It is sometimes helpful to take all medication s ; with you to show your physician so if there are any questions regarding dosage there will be no confusion. 3. Take a small notebook with you to all visits: a. When you ask a question write down the answer. That way, when you get home you won't be frustrated trying to remember what the doctor said to you. b. Before each visit, write down questions you want to ask. c. Ask about your test results and write down the answer. Never assume that everything is "O.K." if you do not hear from the doctor's office 4. Don't stop prescribed medications on your own, even if your symptoms have stopped.
Broward County SHINE Program is announce the debut their SHINE Speakers' group is directed by Area Klombers TheVolunteerBureau. TheBurt Scholl, bothhappy to Coordinator Hubert of counselors and Counselor seasoned public speakers. Five volunteered to be a part of this outreach and publicity effort. Marvin Greisel, Ruth Berns, Sheila Nashban, Gordon B. Gordon and Ben Yaffe attended an initial training meeting at the Area Agency on Aging last June. Techniques on public speaking and topic areas were covered. In August, the group met for a trial run. Each gave a brief presentation on SHINE and provided feedback to one another. Hubert Klombers is looking to use this dedicated group of volunteers to promote the SHINE program and increase the public's awareness of the services and assistance available to elders. Letters are being sent out to senior centers, social-service agencies, hospital discharge planners, condominium associations and legislators offering a free presentation. Topics available include "SHINE -- What It Is, " "How Medicare Works, " "The Balanced Budget Act of 1997" and "Medicare Fraud & Abuse." If you reside in Broward County and would like to arrange a speaker for your group, call Hubert Klombers, SHINE area coordinator, at 954 ; 714-3456 and diflucan, because urge incontinence. Overdose of generic for detrol : any medication taken in excess can have serious consequences.
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Detrol side See FDA-Approved Patient Labeling 17.4 ; . 17.1 Instructions for Use At bedtime, the face should be gently washed with a mild soap and warm water. After patting the skin dry, apply ZIANA Gel as a thin layer over the entire face excluding the eyes and lips ; . Patients should be advised not to use more than the recommended pea sized amount and not to apply more often than once daily at bedtime ; as this will not make for faster results and may increase irritation. A sunscreen should be applied every morning and reapplied over the course of the day as needed. Patients should be advised to avoid exposure to sunlight, sunlamp, ultraviolet light, and other medicines that may increase sensitivity to sunlight. 17.2 Skin Irritation ZIANA Gel may cause irritation such as erythema, scaling, itching, burning, or stinging. 17.3 Colitis In the event a patient treated with ZIANA Gel experiences severe diarrhea or gastrointestinal discomfort, ZIANA Gel should be discontinued and a physician should be contacted. 17.4 FDA-Approved Patient Labeling and effexor. Note: The Mies Krefeld tables are part of a collection. Please refer to Mies side chairs and lounge seating beginning on page 100, for example, vesicare. Drugs like eetrol is one example of keeping up and elocon. Detrol da

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Circulating FGF-23 is detectable in human serum.34, 35 In most patients with TIO, serum levels of FGF-23 are elevated. In a few instances when both presurgical and postsurgical samples have been available, FGF-23 levels have plummeted after complete tumor resection. However, some individuals with TIO have normal levels or only mildly elevated levels, underscoring the heterogeneous composition of phosphatonin. Elevated serum FGF-23 levels are also observed in XLH, albeit to a more modest degree.34, 35 FGF-23 is also central in the pathogenesis of an inherited renal phosphate wasting syndrome, ADHR. Missense mutations in 1 of arginine residues at positions 176 or 179 have been identified in affected members of ADHR families.36 These mutated arginine residues prevent the degradation of FGF-23, resulting in prolonged and or enhanced FGF-23 action.26, 29, 37-39 Additional evidence suggests that FGF-23 may also be key in the pathogenesis of XLH. X-linked hypophosphatemia is caused by mutations in the PHEX gene, 40 which encodes an endopeptidase. Speculation about how loss of endopeptidase activity results in phosphate wasting has led to the hypothesis that FGF-23 is a substrate for PHEX and that failure to cleave FGF-23 prolongs or enhances its activity. Although there is disagreement in the literature, PHEX is thought toeitherdirectly26, 41 orindirectly42, 43 regulate FGF-23. FGF-23 plays a central role in 4 distinct disorders of renal phosphate wasting FIGURE 3 ; . In TIO, tumors produce FGF-23, which then exerts its activity at the proximal renal tubule to inhibit tubular reabsorption of phosphorus and down-regulate 25-hydroxyvitamin D1 -hydroxlase, resultinginhypophosphatemia and osteomalacia. In ADHR, FGF-23 bears mutations that enhance its biological activity and render it resistant to proteolytic cleavage and, again, the result is hypophosphatemia, phosphaturia, bone deformity, and rickets. In XLH, mutatedPHEXdirectlyorindirectly leads to the accumulation of FGF-23 in the circulation and exerts its phospha1265 and evista.
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