Medicine Introduction Center

New orphan drug designation for the treatment of patients with von Willebrand

Thrombotargets Corp. is pleased to announce its second orphan drug designation for the TT-103MH in the treatment of bleeding episodes, now in patients with von Willebrand disease.

TT-103MH in February has granted orphan drug designation for the treatment of bleeding in hemophiliacs. Now Thrombotargets Company recombinant human TT-103MH, was awarded by the Organization of the United States and Drug Administration (FDA), the orphan drug designation for the treatment of patients with von Willebrand “We are very proud of this orphan drug designation. This is the second time the FDA granted a TT-103MH orphan drug designation in less than a year and expects a bright future for the TT-103MH. To increase our market potential, we will continue filling with new applications for orphan drug designation for other bleeding disorders TT-103MH has been active and we believe that the TT-103MH will become a blockbuster in the near future because of this strategy, “said Dr. Pedreño, president and CEO.

About Thrombotargets Group
Thrombotargets (www.thrombotargets.com) is a private biotechnology company focused on the discovery and development of innovative drugs in hemostasis, thrombosis and atherosclerosis. The company has a number of potential new medicines in development internally and objectives UHTS property and innovative platforms are used to program internal drug discovery as well as unlicensed and the association of new research projects.

Medical Collector – Specially Trained For Managing The Bills Of Patients

Medical services are not cost effective and due to such reason often people use to have health insurance to pay for medical treatments. There are such people who don’t have any health insurance to pay the medical treatments bills, and they are bound to pay the bills over the estimated budget. If you are having some issues while paying the medical bills you can consult with medical collectors to have better suggestions.

* The medical collector can communicate with the patients to make sure that the medical organization receives proper payment. The medical collector often has to manage various procedures related to the collection and management of patient’s bills. Previously, there are so many customers or insurance companies were not paying the medical bills.

* But, medical bills are an vital part of health care sectors that continues with the fund operations. So, the medical collector can make a call to the patients to fix the payment issues.

* In this way, the medical collector can solve all the related queries of the patients and medical administrative.

* If you are looking forward to join employment stream as a medical collector, then you need to cover relevant courses or skills such as: computer skill, higher medical education, how to collect patient’s bills, brilliant communication skill, basic of English, perfect writing practice, interpersonal skill, knowledge about the technical database.

The medical offices bill clients routinely & expect the prompt payment, but are well equipped to handle the mild delinquencies with the own internal collections section. As the external collections agencies need the substantial part of an amount collected, and medical offices can first try to collect all debt themselves. The collection method might comprise of telephone calls, letters, mails and (that depends on facilities that are available to medical office) the personal discussions at medical office. Duration of collection effort differs that depends on your office’s policies, and available resources as well as the amount of your debt, but all efforts might continue for 6 to 12 months.

When medical office has already exhausted the resources in trying to collect debt, then it might select to use the collection agency (and compensating it with the part of amount collected) and sell debt to the professional collector at the significant discount. In case, the debt is been sold, then the medical office just writes off debt as loss & collector assumes the ownership of debt.

Buy Canada drugs online to treat many patients

not long ago, Canada drugs were only available in the offline market, but now with the introduction of Internet, Canadian drugs are easily available through online stores of drugs from Canada. Buying drugs from Canada online is simple and convenient as all a customer has to do is simply press enter on your computer. After receiving your order online pharmacies validate a copy of the recipe, then the drugs are delivered to your home within a specified period of time

Canada Online Medications. An economic

Canadian online pharmacies are preferred worldwide by allowing customers to save hundreds of dollars a year. Bring high price these drugs at prices significantly lower than regular stores. If you order the medication from online pharmacies in Canada, then you are one of the patients who have the opportunity to save huge amount and take advantage of unmatched service and quick delivery. Besides online, patients can also apply by mail, fax or phone for your desired drugs.

Buying Drugs Online Canadian Drug Stores

buying drugs from Canadian pharmacies online means huge savings of money, ranging from 35 to 75%. Besides money, but also save time by not forcing customers to visit stores. In addition, their transport is also cost effective and quick. These stores are part of employees educated and trained to advise customers about the availability of drugs from Canada and the application procedure. Customers can contact these professionals whenever they want.

Features Canadian Drug Stores Online

Canadian pharmacies only offer well loved drugs such as Botox, Lipitor, Zocor, Acronel, Plavix and Celebrex, but also other prescription drugs. Patients with a shortage of time also can order them by calling their toll free number is usually mentioned on their website. In addition to discounts on drugs, their services are also available throughout the day. Shops selling prescription drugs in Canada are committed to follow all the rules mentioned by the government to ensure the safety and health of patients. Therefore, an application online and get your medicine delivered at your home you want in the shortest time possible.

have spent time in medical school learning to really care about their patients

medical field has always been an attractive option for many young people. But, recently the focus has shifted to fields of study that monetary rewards and other material benefits of a medical career are passed over in favor of personal fulfillment achieved by working for the public excellent.

A young man recently turned down job offers from more than 000 organizations and medical schools, pharmaceutical companies and private foundations. He founded an organization, while in medical school and prefer to continue with that organization, winning only, 000 a year. This is just one example of the new generation of physicians who are committed to improving the quality and delivery of health care in America.

Wed claims he has no intention of practicing in the traditional medicine. He is the founder of a four-year-ancient dealing with the various communities to study their medical, dental, educational, legal and more urgent. The belief is that the whole community needs to be understood in order to develop better more effective programs for individual health care. The issue here is that there are such opportunities out there for students who want to grow within this niche.

The U.S. are experiencing a crisis in the health field. medical programs are trying to solve these problems, but will need a boost. Medical students are being pushed to the problems and many medical schools across the country have begun to respond to their demands. Most medical students are aware of these problems and want to work to fix.

Dean of the Faculty of Medicine states first that currently tests students a greater degree of social consciousness, a right sense of empathy, a fantastic sensitivity to injustice and clarity of purpose. Students are showing a new level of unity and dedication to service that is often lacking in traditional medical practices, where the motivation was financial. Furthermore, adding that today’s medical students place in much time and energy to achieve their goals. For these people, the lifestyle we have come to associate with the doctors, huge cars, golfing, and material wealth is less of a motivation. Today’s student is very sensitive to not be trapped in the social regimentation.

Students

of modern medicine no longer believe that their medical condition rises above the others. They were part of an exclusive partnership gregarious, being more concerned with wealth and a lifestyle strictly predetermined, which means comfort, security and prosperity. Students present day there is face to face with their counterparts in the older generation.

era of community medicine, where students learn to take care of all being and medical care accessible to all regardless of financial situation, has begun. Despite billions of dollars are spent in the U.S. in health care, patients do not realize any benefits or services they are getting better, according to a professor who is leading the implementation of a reform curriculum and the objectives of the medical schools the nation. Not only have improvements have not noticed, but in the absence of changes in industry conditions of health care tend to deteriorate.

Fortunately, an organization that was formed to encourage medical students to focus more on environmental and public health and preventive medicine. These groups promote awareness and community service through various community outreach programs around the country. This program also works full time for community health projects in classrooms to expose doctors who aspire to them.

Fri Of the students who have participated in several of these projects in the medical community, many have said they want to continue serving the people of these areas as they start their careers as doctors, according to a student who has spent time as the lead agency for the program. Apart from establishing public health clinics and projects in underserved areas, many hospitals and medical training programs are also looking for physicians who are members of minority groups.

Prescription drugs from Canada Pharmacy to help patients Endometriosis

Endometriosis is a common disease in women. The disease causes the lining of the uterus parts found in other areas of the abdomen. The lining of the uterus is often found in the bladder, ovaries, fallopian tubes and various parts of the digestive system. Common symptoms include mild to severe pain in the stomach, pelvis and back. It is also known to the problems of women trying to conceive, but many patients do not experience any symptoms. The reason why the disease occurs is unknown at present;. But there are some possibilities that we discuss in detail below

Medications are available at online pharmacies in Canada, you go in the treatment section.

What happens in endometriosis?

During a menstrual cycle, cells in the uterus increases in size, and is shed during menstruation. The cells involved in endometriosis do the same. Usually before menstruation, the lining of the uterus thickens in preparation for a fertilized egg attaches. If pregnancy does not occur, the lining of the uterus that normally exits the body through the vagina as blood.

The same process occurs with the cells of the endometriosis, but because it is inside the uterus can not leave the body. The cell growth causes pain, swelling and can cause hurt to sexual organs including the fallopian tubes or ovaries, leading to decreased ability to conceive. Most women are diagnosed before age 40.

Is there a cure?

There is currently no cure for the disease. It is a long-term illness that can have symptoms including abdominal pain, fatigue, depression and difficulty conceiving. But, these problems can often be treated with medications for the treatment of pain or hormone.

What are the symptoms of endometriosis?

Different people experience different symptoms. Some of the reported symptoms are stomach painful menstruation, and back pain, pain during intercourse and irregular menstruation.

The severity of pain is different in each patient. Other reported symptoms include pain when urinating, blood in stools and constipation.

How is endometriosis?

endometriosis can be hard to treat. Treatments include pain relief, inhibiting cell growth of endometriosis and increased chances of conceiving. Available therapies are drugs for pain, hormone treatment and surgery.

Canadian online pharmacies supply of certain medications and endometriosis RX drugs that are proven to help with the symptoms of endometriosis.

Canadian pharmacy drugs online can help?

anti-inflammatory drugs like ibuprofen and naproxen are a common treatment because they help reduce swelling in endometriosis, while at the same time reduce the pain.

Danocrine is one of the drugs available in Canada online pharmacies for the treatment of endometriosis, and is a synthetic (artificial), treatment with steroid hormones, which has been shown to improve fertility and reduce pain patients.

online pharmacies in Canada also offer Aygestin is a progestin hormone indicated for use in patients with endometriosis.

Hormone treatments for endometriosis

is the female hormone estrogen, and promote cell growth of endometriosis. Hormonal treatments, such as those available from Canadian online pharmacies aforementioned prevent estrogen production and subsequently reduces the growth of endometriosis. When no estrogen, the symptoms of endometriosis is reduced.

combined pill

combined pill has estrogen and progestin in it. It is not an official treatment for endometriosis, but because of reports of patients symptoms are alleviated by taking the combined pill, doctors often recommend this treatment. Online pharmacies in Canada and online stock RX drugs these providers, and can be delivered to you via mail order.

drugs Medicaid patients “go to dealers Rx

drugs Medicaid patients “go to dealers Rx

Ethel Johnson could not get their prescription pain medication filled quick enough. The Buffalo woman 60 years of age, it hurt – but researchers say it was not the reason for the rush

.

According to telephone conversations secretly recorded, Johnson could soon pick up their pills, quicker than the dealer could sell. His pain pills went to the street.

Wed Johnson is one of 33 people charged so far in a large-scale research has opened a window to an emerging class of providers in the drug trade: the medical patients, including many who depend on public funding for the Medicaid program to pay for appointments and prescriptions. She has pleaded not guilty.

For the first time, researchers gave Buffalo the type of resources normally for drugs like heroin or crack cocaine – wiretaps, purchasing, monitoring and cooperation between agencies to track drugs from the pharmacy on the street. Even they were surprised by the growing market for the types of pills found in medicine cabinets in the typical U.S. home.

“I have to admit they were a sort of surprise at how huge it had become,” said Charles Tomaszewski, a former supervisor of the office DEA. “suburbs, the city, no area that was not touched by this.”

often at no cost, patients see a doctor or more physicians, and hanging out with drug prescriptions for OxyContin and other pills that they sell to a distributor to the extent, 000. If you are on Medicaid, the program is charged around 060 for a typical 60 pills, the prescription of 80 mg, along with the cost of the visit the physician.

“These patients, in essence, become the source of the drugs,” said Dale Kasprzyk, acting head of the Drug Enforcement Administration at Buffalo.

“This is a lucrative business for people underground,” he said.

A report last year by the Government Accountability Office estimated that 65,000 Medicaid recipients in New York and four other states have visited six or more doctors in fiscal 2006 and 2007 to a doubling of prescriptions for controlled substances.

Medicaid cost was million for drugs alone, excluding medical examinations. The report examined Medicaid abuse in New York, California, Illinois, North Carolina and Texas, states of high volume of Medicaid payments for prescription drugs.

OxyContin, an extended release formulation of oxycodone, value packages 12 hours of pain relief in one tablet. It is especially appreciated by the drug, officials said, because it can be crushed and swallowed, inhaled or injected by the full impact of drugs, a run similar to heroin .

criminal cases in July by the U.S. Attorney’s office in Buffalo William Hochul illustrate how patients are trained on which doctors to see and what to say when they get there. Prosecutors in the court documents in November, said the plea agreements are under negotiation.

“Tell him, you know, you know you’ve been in a lot of pain, throat complaint. And then, you know, even throw some of that pressure on your baby “, the alleged kingpin Michael McCall Buffalo a patient tells 40-year-ancient vendor in a conversation recorded by investigators.

“We must tell the doctor that you need to climb to 90 (pills) because … has been taking three a day and ran out before, “he says.

The other patient, a 60-year-ancient McCall says a doctor insists on a urine test to make sure it is taking prescribed medication, McCall says, “Want some?” and offers to take her home urine.

Dealers

not have to retrieve their money together, smuggling or to reach the connections Mexico or anything, “said Tomaszewski, who helped supervise the enforcement Buffalo before becoming deputy city commissioner of police.” They were smart enough to find sources of supply were in their own neighborhood. “

After buying the tablets of the patients, distributors resold for an average of one milligram, the researchers say. With a single sale of OxyContin 80 mg, 90 count bottle of pills McCall says he paid, 000 or less worth it, 200 on the street. The authorities say he would meet with their suppliers in the pharmacy parking lot or pick up the pills at home. – Even get prescriptions filled some patients, signing for them at the pharmacy

After OxyContin was introduced in 1996, quickly became the top prescribed analgesic in the nation, and among the most consumed. The Food and Drug Administration approved in April a new version of the painkiller with a layer designed to make the drug more hard to crush and snort or inject. States have cracked down well with New York and taking other prescription pills tamper-proof.

To reduce the abuse of Medicaid patients, several states, including Alaska, Florida, Maine, Michigan, South Carolina and West Virginia, require state approval before OxyContin prescriptions filled, according to the National Conference State Legislatures.

New York Office of Inspector General Medicaid beneficiaries restricted to cover only one doctor and the pharmacy only if the doctor suspected of trade, a spokesman for Fischer said Wanda. Nearly 10,000 New York beneficiaries are now in a restricted state, he said.

“We’re not allowed to fall from the Medicaid program unless they prove a crime has happened,” Fischer said.

McCall, Johnson and his co-defendants are charged with possession and distribution of oxycodone and hydrocodone, two pain medications most commonly prescribed and abused opiates, but authorities say that several depressants and stimulants has changed hands, too.

McCall also is charged with operating a criminal enterprise for allegedly managing a stable of more than 20 patients, suppliers – many of them men and women in their 50s and 60s and covered by Medicaid – whose prescriptions researchers said he would buy and then distributed to a well-organized network of vendors.

Johnson declined an interview request after his arrest and his lawyer, Robert Goldstein, declined to discuss the case. lawyer McCall also declined comment.

DEA does not track how many defendants in drug cases are the beneficiaries of Medicaid, said a national spokesman.

“In the group (Buffalo ), some people believe that has had medical problems or sell a part or all of their medications, “Kasprzyk said,” and there are some who believe they have no medical problems, but to deceive physicians. “

At the age of 60 and making the rounds in a white Cadillac Escalade, 2007, McCall was less intimidating for those who saw to it that drug dealers on the street, they tend to adapt to a more younger, more violent profile.

“It will appeal to older people, who would talk to them,” Kasprzyk said. “He did what he had to do to develop a relationship with people and make back

Emergency medicine job description and patients

Not everyone can be an emergency physician and not everyone can rescue the patients in a timely manner. There are people that are not quick enough for the emergency room. They can’t reckon as quickly as the emergency physician. Different physician have different capacity and abilities and not everyone can become an emergency physician. There are doctors that preferred a slower pace type of work rather than the emergency room. The emergency room is for those that are truly experienced and they like the quick pace environment. They reckon that they can handle it. They can rescue the patients or treat them well. Not everyone want to rescue patients in a rush, they want to take their time and you can’t do that in the emergency room.

The emergency physician has to be experienced and quick. If you wait thirty minutes on some cases, the patients might die. What if you are unsure and it takes you about thirty minutes to come up with a treatment plot? This is why emergency physician needs to be experienced. They need to know exactly what they are doing. They need to be familiar with all of the emergency cases out there. If someone comes in with a heart attack, the emergency physician will need to rescue them or else they can die. This is why it’s very critical in the emergency room. The staff and the emergency physician needs to be on their feet waiting for the next patient that is rushed into the ER room. The emergency physician needs to have a lot of patients because it’s hard to rescue the patients and you might not see result straight away. It can be frustrating when patients pass away in the ER room and it’s not uncommon. The emergency physician would need to be comfortable with trauma and drama. He needs to deal with hard situation like death with a fantastic level of acceptance and professionalism. There could be physicians who would blame themselves if their patients pass away. They would feel terrible about their competency in front of colleagues and patient’s family. There are physicians that can’t handle all sorts of criticisms or rage when a patient dies.

It’s mentally draining if you have an unsuccessful case in the hospital and this is something that an emergency physician needs to be comfortable with. The emergency physician has to do his job well and be comfortable with all that is going on around him. Emergency medicine is a quick pace type of work and this is why medical students really need to be sure that they can handle the real work environment. It’ll be different from medical school or residency. You have to be in charge for the patient’s rescuing and you can’t consult or question your professor. You’re pretty much on your own with a few colleagues around. This is the kind of job that you’ll going sleep thinking about it. It’s not simple.

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Managing Patients medical cards software

A strong family and caregiver support system is vital to the continued treatment of mental health patients after they leave the hospital. In fact, it is critical in assisting with medication adherence to ensure consumers appear for their appointments with service providers, particularly during transition between inpatient and outpatient settings. But, when discussing family support systems, some physicians contest that less than half of consumers have an “adequate” social support system to meet their daily needs. Because a strong family support system cannot be “manufactured” or bought through funding, it is vital to focus on other controllable issues that can make a positive impact on the continuity of care for mental illness patients. A recent mental health study identified three factors that positively influence the efficiency of the transition process between inpatient facility discharge and intake with a community-based program. These include: * when communication occurs “within system” * when computer systems/consumer records are shared * when an ACT (or similar) team is involved Of course, in addition to having a strong family and care support, there are other issues involved. Public policy and government funding are two particularly impactful issues. From a mental healthcare systems perspective, matters involving policy and financing issues impacting continuity of care can be conceptualized along two broad approaches: 1. ) Building service coordination into the payment rates and expectations for certain services. This approach is conceptually similar to what is referred to as Primary Care Case Management in some disease management or chronic care programs. 2. ) Defining certain consultation and care coordination services as covered benefits. Under the first approach, consultation and care coordination would be a defined benefit with its own billing codes and defined coverage limits, eligible providers, allowed situations, and limitations and exclusions. For example, situations where this might be applicable include: hospital discharge plotting and small-term transition support; developmental transitions (e. g. child to adult); coordination between primary care and mental health providers; consultation with primary care; consultation with other professionals to implement treatment plans (e. g. schools, residential programs); clinical coordination among multi-disciplinary teams, especially home-based services. Under the second approach, coordination of care is built into “programs of mental healthcare” or episodes of care. This concept is seen in current disease management models and chronic care models and can include: assertive community treatment, multi-systemic therapy, and Dialectical Behavioral Therapy (DBT). Hospital payment methods assume linkage with step-down, aftercare, and outpatient services, similar conceptually to Medicare Part A that covers hospital stays and 100 days of nursing home or home health rehabilitation as follow-up, when necessary. Levels of communication between various clinicians and other staff in inpatient and outpatient settings can vary greatly, impacting continuity of therapy. Typically, there is very small communication between psychiatrists in inpatient and outpatient facilities and this applies as well to nursing staff in these two settings. The most frequent communications occur between inpatient discharge planners and outpatient intake coordinators. Three specific models of interaction between inpatient and outpatient facilities have been identified: * “Push” Model: In this model, the outpatient setting is highly dependent on the inpatient setting and/or the consumer for receiving documents. * “Integrated” Model: With this model, the sharing of resources provides a continuum of care for consumers, so there is never really a “gap” between discharge and intake. * “Pull” Model: For this model, a member of the outpatient treatment team actively participates in the discharge process, which leads to the timely receipt of appropriate/relevant documents, as well as increased consumer participation. Despite the link between positive consumer outcomes and continuity of therapy, it remains unclear, in many cases, how referrals are made throughout the system of care; how hospital and program admission criteria are developed and applied; how consumers are discharged from hospital settings and into the community; and who is responsible for their care. Data regarding who is going to hospital emergency departments for acute psychiatric care and why they are in that setting rather than in community mental health program are scarce, as are data about individuals who could be went out of hospital emergency rooms if consumers were provided with better transition services or if appropriate acute psychiatric care were available in other settings. The same observation can be made regarding those individuals who could be went out of state psychiatric hospitals if appropriate services such as care management, medication management, housing, and employment supports were available in the community. Obtaining these observations and data of this kind is a huge and vital step in ensuring a continuity of care for all mental illness patients.

If you happen to be one of those doctors who spend more time hooked to your computer trying to memorize illness codes than doing things that a real doctor does then you sure have a problem. Spending a huge amount of time with the medical insurance company over the phone trying to clarify what procedure you performed on which patient and why is not what you had envisioned while signing up as a medical practitioner. Disheartening but this is what clinical practice is reduced to these days unless you have a competent medical billing consultant. Understanding the needs of health care providers’ way back in 1998, Active Management has been providing medical billing solutions for the last eleven years. Numerous guidelines and compliances that one needs to take care of in medical billing services makes the services of a medical billing consultant indispensible. Any medical practitioner is likely to feel at disadvantage if his focus is shifted from patients care to managing his. With its strongholds on medical billing services and medical billing practices, this is where Active Management steps in. Check out the whole range of medical billing solutions offered by Active Management at www. activmds. com At Active Management a team of Certified and trained electronic medical billing specialists work in tandem to provide you with effective and affordable medical billing solutions and medical insurance billing. They make sure that only HIPAA compliant procedures and processes are followed. If you have been trying to work on medical billing you must be familiar with x12-270 or x12-271 and other such formats. Well, it’s really not your fault if you find the whole thing very confusing because that’s really the job of a specialist. And that’s what you get when you avail medical billing services of Active Management. An army of electronic medical billing specialists. Will help you to ensure your zero defect performance in medical billing practices. As they say, “devil is in the detail” so the medical billing consultants at Active Management give fantastic attention to the details. A comprehensive and detailed case history will not only benefit the patient but also you. World class medical billing solutions provided by Active Management start by immaculate data entry to ensure high percent of reimbursement rate along and certain carrier acceptance. Log on to www. acticmds. com for all your medical billing needs. As a health care provider, if your major concern is patient’s health and recovery and medical billing is eating into your time, medical billing services available at Active Management is something tailor made for you.

More and more consumers are taking herbal supplements as an alternative treatment for their diseases.   It is estimated that more than 15 million people in the US consume herbal remedies or high-dose vitamins, and the total number of visits to the complementary medicine providers far exceeds those to primary physicians.

Lack of efficacy and adverse effects associated with prescription medicines lead many patients to explore herbal medicines.   Uses of herbal medicines, but, are not without any risks.   Although most of these herbal medicines have excellent safety profile, some herbal medicines have not been shown to be efficacious.   Some even interact with western medicines, leading to life-threatening consequences. (Table 1)

The purpose of this paper is to equip cardiovascular patients with the latest uses of commonly used herbal medicines and the potential interaction of these herbal medicines with prescription medicines.   Patients are advised to inform their primary care physicians and their specialists of the herbal supplements they are taking and to limit the use of herbal medicines to a shorter time period.

A) Aconite

Uses

Traditional Chinese practitioners use aconite for pain relief caused by trigeminal and intercostal neuralgia, rheumatism, migraine, and general debilitation.

Drug interaction

Long term use might increase the risk of atrial or ventricular fibrillation.  

B) Black cohosh

Uses

Black cohosh has been used to relief symptoms of menopause, pre-menstrual tension and other gynecologic problems.

Drug interaction

Black cohosh should not be used with estrogen replacement therapy (ERT) since the combination of black cohosh and ERT has been shown to increase the risk of cardiovascular events and breast cancer.   Pregnant and lactating women should avoid taking black cohosh.

C) Danshen

Uses

Danshen is used in traditional Chinese medicine for the treatment of coronary artery disease and menstrual abnormalities.

Drug interaction

Danshen reduces the elimination of warfarin and increases the bleeding risk associated with warfarin.   It also interferes with digoxin essay.

D) Echinacae

Uses

Echinacae is used to strengthen the immune system to prevent infections.   Side effects of Echinacae include nausea, dizziness, dyspnea, rash, and dermatitis.

Drug interaction

Long term use may increase the liver toxicity of other medications (e. g. , statins(Zocor, Lipitor, Crestor), fibrates (Bezalip, Lopid and Tricor), niacins (niaspan), or amiodarone(codarone)).

E) Ginseng

Uses

Ginseng is advertised as an immune system stimulant that increases vigor, sexual potency and longevity.    It is also used to treat myocardial infarction, congestive heart failure (CHF), angina pectoris and hyperglycemia in diabetic patients.  

Drug interaction

Concomitant use of ginseng and warfarin results in an increase in bleeding time while use of ginseng and digoxin causes an increase in digoxin level.   Pregnant women or women receiving hormone replacement therapy are advised not to use Ginseng since ginseng contains ingredients similar to estrogen.   Also, long use of ginseng might result in reduced responsiveness to loop diuretics.

F) Ginkgo

Uses

Ginkgo is used for cardiovascular disease, cerebrovascular or peripheral vascular insufficiency, importance, inner ear dysfunction, retinopathy, pre-menstrual syndrome, stress, depression, and dementia.

Drug interaction

The concurrent use of ginkgo with antiplatelet (aspirin, Plavix, Effient, Aggrrastat and ReoPro), anticoagulant (warfarin) or antithrombotic agents (Streptase) increases the risk of bleeding.   In clinical trials, ginkgo has also been shown to reduce the effectiveness of antihypertensive nicardipine (Cardene).

G) Garlic

Uses

Garlic has been used to treat infectious conditions since 1550 BC, due to its antimicrobial and immune-enhancing properties.  Garlic has also been promoted to prevent cardiovascular disease because of its cholesterol-lowering, antihypertensive, antiplatelet and fibrinolytic properties.

Drug Interaction

Patients taking anticoagulant or antiplatelet agents should avoid taking garlic supplements since garlic increase the risk of bleeding.   Patients taking aspirin, warfarin and garlic supplements are advised to discontinue the garlic supplements for at least 10 days before elective therapy

H) Grapefruit juice

Uses

Grapefruit juice is used as a dietary intervention to lose weight and to improve cardiovascular health.  

Drug interaction

Grapefruit juice increases the blood level of calcium-channel blockers (Norvasc, Plendil, Cardif and Cardene), cyclosporine (Sandimmune, Neoral, Cicloral and Gengraf), statins (Lipitor, Zocor, Crestor), midazolam (Dormicum, Versed and Hypnovel), estrogen and terazoin (Hytrin).  

I) Gynura 

Uses

Gynura is used widely in Chinese medicine to improves microcirculation and relieve pain.  

Drug interaction

Gynura interacts with angiotensin-converting enzyme drugs (e. g. Vasotec, Altace, Accupril, Zestril, Prinivil, Lotensin, Cozaar, Diovan, Benicar, Avapro and Micardis ).   Long term use has been associated with hepatic toxicity.

J) Hawthorn 

Uses

Hawthorn extract is used mostly to treat angina, CHF, bradyarrhythmia and cerebral insufficiency.  

Drug interaction

Hawthorn enhances the effect of digitalis (Digoxin) and increases the risk of bleeding in patients taking antiplatelet or anticoagulant agents.   Patients who take digitalis, antiplatelet, anticoagulant and Hawthorn need to monitor for potential toxic effects.

K) Licorice

Uses

Licorice is used as an expectorant.   Long term use might result in pseudoaldosteronism, hypokalemia, hypertension, ventricular arrhythmia, hyperglycemia and edema.  

Drug interaction

Licorice increases the effects of spironolactone (Aldactone) and digoxin.   It also interacts with antiplatelet, anticoagulant and antidiabetes agents (e. g. Lantus, Amaryl, Januvia, Metformin, Diamicron, Actos, Glucophage, Byetta and Advandia), rendering these agents less effective.

L) Motherwort 

Uses

Motherwort is use in both European and Asian traditional medicine to treat cardiac weakness, rapid heart beat, anxiety, insomnia, hypertension, amenorrhea, and edema.  

Drug interaction

When taken with benzodiazepines for insomnia, motherwort increases the sedative effect of benzodiazepines and might result in coma.

M) Saw Palmetto 

Uses

Saw Palmetto is used for the treatment of benign prostatic hypertrophy (BPH), hypertension and urinary infections.

Drug interaction

Saw Palmetto increases the risk of bleeding in patients taking warfarin.   When use in long term, saw palmetto might increase in the risk of cholestatic hepatitis, acute pancreatitis and intro-operative floppy iris syndrome.

N) St. John’s wort 

Uses

St. John’s wort is typically used to treat depression, anxiety, sleep disorders, common cold, herpes, ulcerative colitis, pain and the human immunodeficiency virus.

Drug interaction

Since St. John’s wort decreases the prothrombin time of warfarin and increase the risk of stroke, people taking warfarin who have a history of stroke, thrombosis, atrial fibrillation or prosthetic cardiac valves should avoid the use of St. John’s wort.    

Also, patients who take ethinyl estradiol, indinavir (Crixivan), cyclosporine, statins and digoxin will have the level and efficacy of these drugs reduced.  

Lastly, patients who take antidiabetes agents and St. John’s wort should watch out for hypoglycemia since St. John’s wort potentiate the glycemic effects of antidiabetes agents.

O) Tetrandrine 

Uses

In Chinese medicine, tetrandrine is used to treat hypertension and angina.  

Drug interaction

Tetrandrine lower glucose level and might cause hypoglycemia in diabetic patients.   Long term use might cause hepatotoxicity and renal toxicity.

P) Yohimbine 

Uses

Yohimbine is used for the treatment of sexual disorders and exhaustion.  

Drug interaction

Yohimbine reduces the efficacy of antihypertensive and diuretics.   Yohimbine is contraindicated in patients with hypertension, angina, and renal impairment.

Conclusions

Use of herbal remedies is widespread and is increasing dramatically.   These remedies, but, are not subjected to the same regulations as prescription drugs.   Thus, the purity, efficacy and safety of herbal products are not always known and some products may not even contain the amount of active ingredients listed on the mark.   Furthermore, some of these herbal remedies posses serious drug interaction with prescription medicines.   

Cardiovascular patients who are taking prescription medicines with narrow therapeutic index such as digoxin and warfarin are advised to consult their physicians before taking any herbal medicines and to take these herbal medicines for a small period of time.

Drug Class and Brand Names

Angiotensin-converting enzyme drugs = Vasotec, Altace, Accupril, Zestril, Prinivil, Lotensin, Cozaar, Diovan, Benicar, Avapro and Micardis

Anticoagulant = warfarin

Antidiabetes agents = Lantus, Amaryl, Januvia, Metformin, Diamicron, Actos, Glucophage, Byetta and Advandia

Antiplatelet = aspirin, Plavix, Effient, Aggrrastat and ReoPro

Antithrombotic agents = Streptase

Calcium-channel blockers = Norvasc, Plendil, Cardif and Cardene

Cyclosporine = Sandimmune, Neoral, Cicloral and Gengraf

Digitalis = Digoxin = Lanoxin

Indinavir = Crixivan

Midazolam = Dormicum, Versed and Hypnovel

Spironolactone = Aldactone

Statins = Lipitor, Zocor, Crestor

Terazoin = Hytrin

 

Tachjian A et. al. JACC Vol. 55, No. 6, 2010

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As Congress debates the future of health care for our nation, it is vital to review the legislative efforts of Sen. Tom Carper to promote wellness and reduce the probabilities of an individual developing a chronic disease      The Ensign-Carper amendment allows employee-sponsored health plot costs to be cut by as much as 50 percent for those who engage in healthy behaviors. If it is part of the final bill, the amendment will provide incentives to Americans to lead healthy lifestyles in order to lower their overall health care costs. These programs have been found to be successful in smoking cessation, weight loss and preventive care programs. One of the most serious problems that confront medical practitioners and patients alike is failure of the patient to follow treatment regimens. Patients who do not follow the treatment plot are more likely to be ill, have a reduction in quality of life, miss work or school, require medical care and become disabled. A study examining the relationship of total costs of diabetes care to treatment adherence found that individuals with adherence greater than 80 percent had half the annual costs of those with adherence of less than 20 percent. It is estimated that 50 percent of chronically ill individuals do not consistently follow treatment recommendations. The cost of care each year attributable to non-adherence has been estimated to be $100 billion. I would like Delaware’s congressional delegation to consider extending the model of incentives to individuals with chronic disease, an area of potentially greater cost savings. The Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion reported that the medical care costs of people with chronic diseases in 2005 accounted for more than 75 percent of the nation’s $2 trillion in medical care costs. Until these chronic diseases can be prevented, physicians will continue to prescribe the most effective treatments and medications to control disease progression. Surprisingly, there are only a few adherence programs that have been demonstrated to be cost-effective. Sen. Carper is familiar with my outcome research reducing hospital and emergency care for children with severe asthma, conducted at the Alfred I. duPont Hospital for Children. Fifty-nine children with frequent hospital care (median of seven hospital days and four emergency visits the year prior to admission) received medical treatment, education and counseling in an inpatient setting for 10 days. They were followed for four years as outpatients, and the median number of hospital days and emergency care visits for each year of follow-up was 0. This was associated with a 76 percent reduction in charges for asthma care. These results were achieved by helping the families adhere to a complex asthma treatment plot. In 2002, the Medical Society of Delaware convened a state-wide stakeholder’s conference to discuss a report from the Medication Adherence Task Force on asthma care. Stakeholders recommended that asthma patients have incentives to follow a treatment plot and stay healthy. These included reduced or no co-pays for medications, scheduled well-office visits and necessary equipment to measure lung function and treat asthma symptoms at home. While there are many reasons other than cost that are responsible for poor adherence to therapy (e. g. side effects, depression, etc. ) cost has been relatively simple to study. Researchers found that the addition of a fixed $20 co-payment or 25 percent co-insurance reduces adherence to cholesterol-lowering drugs by 5 percent, with larger reductions in adherence observed in low-income patients. Adult asthmatics in Asheville, N. C. , who received both counseling and free medication from pharmacists had significantly reduced overall asthma-related costs despite increased medication costs that resulted from increased use. These studies confirm the validity of the recommendations of the Medication Adherence Task Force Stakeholders’ Conference and support legislative action for incentives, such as reduced or no co-pays, for responsible, chronically ill, medication-dependent citizens. I believe Sen. Carper’s philosophical approach to promoting individual responsibility and maintaining health could easily be extended to those with chronic diseases.