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      Condición de venta de analgésicos antiinflamatorios no esteroides, legalmente autorizados para su comercialización en Colombia. Estrategias de uso racional Translated title: Condition of sale of non-steroidal anti-inflammatory drugs authorized for marketing in Colombia. Strategy of rational use

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          Abstract

          La condición de comercialización (venta libre, con fórmula médica, bajo control especial o para uso hospitalario exclusivamente) determina las circunstancias en las cuales puede ser publicitado y comercializado un medicamento. La venta libre no involucra una consulta al equipo de salud, quienes no participan de la selección del medicamento, su dispensación ni seguimiento fármaco-terapéutico. El presente trabajo, mediante un estudio observacional descriptivo de corte transversal desarrollado partiendo del universo de registros sanitarios de medicamentos en Colombia, identifica y describe las variaciones en la condición de venta de analgésicos antiinflamatorios no esteroides. Para este grupo farmacológico, de gran consumo en el país, predominan la modalidad de registro "fabricar y vender", las formas farmacéuticas sólidas no estériles, la condición de venta con fórmula médica y la vía de administración enteral; asimismo, predomina como principio activo el diclofenaco, seguido de ibuprofeno y piroxicam. Ocho de los principios activos de este grupo farmacológico poseen doble condición de venta (venta sin prescripción facultativa o libre y venta con fórmula médica) y alcanzan el 70% de las autorizaciones de comercialización de aines en Colombia. Se evidencia una relación entre la cantidad principio activo por unidad posológica y la condición de venta autorizada, relación que no es evidente con respecto a la indicación.

          Translated abstract

          The commercialization status (otc, under medical prescription, under special monitoring or for hospital use only) sets out the circumstances under which it may be publicized and marketed a drug. The otc does not involve consulting the health team, who do not participate in the selection of the drug, its dispensing or therapeutic monitoring. Present work through an observational, descriptive, cross-sectional study from the universe of Colombian drug approvals, identify and describe the variations in the condition of sale of non-steroidal anti-inflammatory drugs. For this pharmacological group, widely consumed in the country, dominated the modality "make and sell", the non-sterile solid dosage forms, the condition of sale under prescription and the enteric route of administration, likewise predominate as active substance diclofenac, followed by ibuprofen and piroxicam. Eight of the active ingredients of this pharmacological group have double condition of sale (otc and under medical prescription) achieving 70% of marketing authorization for nsaids in Colombia. It is evidenced a relationship between the amount of active substance per dosage unit and the commercialization status, a relationship that is not evident with respect to the indication.

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          Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis

          Objective To analyse the available evidence on cardiovascular safety of non-steroidal anti-inflammatory drugs. Design Network meta-analysis. Data sources Bibliographic databases, conference proceedings, study registers, the Food and Drug Administration website, reference lists of relevant articles, and reports citing relevant articles through the Science Citation Index (last update July 2009). Manufacturers of celecoxib and lumiracoxib provided additional data. Study selection All large scale randomised controlled trials comparing any non-steroidal anti-inflammatory drug with other non-steroidal anti-inflammatory drugs or placebo. Two investigators independently assessed eligibility. Data extraction The primary outcome was myocardial infarction. Secondary outcomes included stroke, death from cardiovascular disease, and death from any cause. Two investigators independently extracted data. Data synthesis 31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death. Conclusions Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug.
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            Abuse of prescription drugs and the risk of addiction.

            Abuse of several categories of prescription drugs has increased markedly in the United States in the past decade and is now at alarming levels for certain agents, especially opioid analgesics and stimulants. Prescription drugs of abuse fit into the same pharmacological classes as their non-prescription counterparts. Thus, the potential factors associated with abuse or addiction versus safe therapeutic use of these agents relates to the expected variables: dose, route of administration, co-administration with other drugs, context of use, and expectations. Future scientific work on prescription drug abuse will include identification of clinical practices that minimize the risks of addiction, the development of guidelines for early detection and management of addiction, and the development of clinically effective agents that minimize the risks for abuse. With the high rates of prescription drug abuse among teenagers in the United States, a particularly urgent priority is the investigation of best practices for effective prevention and treatment for adolescents, as well as the development of strategies to reduce diversion and abuse of medications intended for medical use.
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              Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis.

              To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs. Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation. Hospital and community based case-control and cohort studies. (a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies. 12 studies met the inclusion criteria. 11 provided comparative data on ibuprofen and other drugs. Ibuprofen ranked lowest or equal lowest for risk in 10 of the 11 studies. Pooled relative risks calculated with exposure to ibuprofen used as reference were all significantly greater than 1.0 (interval of point estimates 1.6 to 9.2). Overall, ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those with naproxen and indomethacin. The low risk of serious gastrointestinal complications with ibuprofen seems to be attributable mainly to the low doses of the drug used in clinical practice. In higher doses ibuprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs. Use of low risk drugs in low dosage as first line treatment would substantially reduce the morbidity and mortality due to serious gastrointestinal toxicity from these drugs.
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                Author and article information

                Journal
                rccqf
                Revista Colombiana de Ciencias Químico - Farmacéuticas
                Rev. colomb. cienc. quim. farm.
                Departamento de Farmácia, Facultad de Ciencias, Universidade Nacional da Colombia (Bogotá, Distrito Capital, Colombia )
                0034-7418
                1909-6356
                June 2013
                : 42
                : 2
                : 145-168
                Affiliations
                [01] Bogotá, D. C orgnameUniversidad Nacional de Colombia orgdiv1Departamento de Farmacia orgdiv2Grupo de Investigación FaMeTra (Farmacología de la Medicina Tradicional y Popular Colombia Correo electrónico: ggaravitoc@ 123456unal.edu.co.
                Article
                S0034-74182013000200001 S0034-7418(13)04200201
                6ea6ddc1-9046-4b8a-a7cc-e1e418910f7c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 31 July 2013
                : 13 September 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 24
                Product

                SciELO Colombia

                Categories
                Artículos

                nonprescription drugs,registro sanitario,aprobación de medicamentos,medicamentos bajo prescripción,medicamentos sin prescripción,agentes antiinflamatorios no esteroides,prescription drugs, drug approval,non-steroidal (nsaids),Anti-inflammatory agents

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