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The Family Inventory of Life Events and Changes FILE ; Appendix B; items 22-92 ; evaluated the pile-up of life events experienced by a family the aA factor of the Double ABCX model ; and was originally designed by McCubbin, Patterson and Wilson as an index of family stress McCubbin, Patterson & Wilson, 1979 ; . Over a period of time, FILE Form C ; has been. Hypovascular ; have also shown a good response and this may be related to the fact that some have greater vascularity. The Japanese literature suggests a difference when TACE is performed selectively subselectively vs. non-selective. They also don't repeat the procedure if there is a morphologic response whereas the randomized studies noted above continued repeatedly and may have led to decreased liver function. Focal HCC has been shown to have less recurrence than multinodular. Lesion size, number, location, bilobality and alpha fetal protein did not have anything to do with survival. Portal vein involvement does not preclude increased survival. Another controversy is whether the chemo portion of chemoembolization adds anything. There is no definite evidence that the chemo portion of chemoembolization adds anything to survival. Yoshikawa et al showed that the addition of Lipiodol yields a better response rate than just the drug alone. One-year survival was also improved. Chemotherapy was felt to contribute to post procedure morbidity. Chang et al reported that the addition of cisplatin to gelfoam and Lipiodol did not add to survival and survival in the control group no cisplatin ; was the same. The only difference was more vomiting post procedure with cisplatin. A recent meta-analysis 2002 ; included 2, 466 patients from 18 randomized controlled studies. Their results showed that TACE significantly reduced the overall 2-year mortality when compared with no therapy. In addition, they found that embolization without a chemotherapeutic agent TAE ; had less mortality than TACE. This suggested that the addition of chemotherapy may not only be of no use but may actually be detrimental by exacerbating liver failure. Also, success is better in patients with Child class A and B as opposed to C. Essentially TACE is not for everyone. The procedure, its dose and its repetitions must be individual to the patient. Adverse effects associated with the use of CM are a direct outcome of the pharmacologic action of the stimulant. In addition to the tachycardia, hypertension, anorexia, insomnia, and diaphoresis previously described, patients have experienced psychosis, aggression, paranoia, mydriasis, hyperthermia, seizures, and encephalopathy.29, 30 On occasion, hemorrhagic and ischemic strokes, rhabdomyolysis, and renal failure have been reported.17, 32Acute withdrawal symptoms, typically beginning 24 hours and peaking at about 72 hours after the last dose, include gastroenteritislike symptoms, a tremendous desire to sleep, a ravenous appetite, and moderate-to-severe depression.17, 29, 32 Ingestion of 1.5 mg kg has been associated with death; however, long-term abusers can ingest doses up to 15, 000 mg kg and tolerate such an amount.32. Make sure you know how you react to maxalt before you drive a car, operate machinery, or do anything else that could be dangerous if you are sleepy or dizzy.
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Irinotecan, 129 received 5-FU, and 90 received best supportive care. Eleven 3.5% ; patients treated with irinotecan died within 30 days of treatment. In three cases 1%, 3 316 ; , the deaths were potentially related to irinotecan treatment and were attributed to neutropenic infection, grade 4 diarrhea, and asthenia, respectively. One 0.8%, 1 129 ; patient treated with 5-FU died within 30 days of treatment; this death was attributed to grade 4 diarrhea. Hospitalizations due to serious adverse events whether or not related to study treatment ; occurred at least once in 60% 188 316 ; of patients who received irinotecan, 63% 57 90 ; who received best supportive care, and 39% 50 129 ; who received 5-FU-based therapy. Eight percent of patients treated with irinotecan and 7% treated with 5-FU-based therapy discontinued treatment due to adverse events. Of the 316 patients treated with irinotecan, the most clinically significant adverse events all grades, 1-4 ; were diarrhea 84% ; , alopecia 72% ; , nausea 70% ; , vomiting 62% ; , cholinergic symptoms 47% ; , and neutropenia 30% ; . Table 9 lists the grade 3 and 4 adverse events reported in the patients enrolled to all treatment arms of the two studies described in the CLINICAL STUDIES, Studies Evaluating the Once-Every-3-Week Dosage Schedule, section.
Only small increases in ability to withstand saline conditions. One important factor limiting the potential tolerance of all wheat varieties may be the high unidirectional influx of Na into the root, which is very similar in both tolerant and sensitive varieties Davis, 1984; Davenport et al., 1997 ; . This is confirmed by patch-clamp data showing no differences in the channel populations of the same varieties Schachtman et al., 1991; Findlay et al., 1994 ; . Na influx is much higher than net uptake in these plants, and so requires a high rate of active Na extrusion from the roots. Therefore, the growth of both so-called tolerant and sensitive species may be limited by the energetic cost, and incompleteness, of this Na expulsion, accounting for the relatively small varietal differences observed. Thus, it is likely that the identification and modification of toxic Na uptake mechanisms at the root plasma membrane will be necessary before any dramatic improvements in the salinity tolerance of wheat can be expected. The transporter s ; responsible for toxic Na influx into wheat have not been identified, although several molecular candidates have been partially characterized. HKT1, a high-affinity Na K cotransporter from wheat, can also function as a relatively low-affinity Na Na cotransporter at high Na concentrations Rubio et al., 1995; Gassmann et al., 1996 ; . However, the membrane location of HKT1 and evidence for its role in the nutritional uptake of K have not been established Walker et al., 1996 ; . Moreover, HKT1 is apparently insensitive to inhibition by Ca2 Schachtman et al., 1997 ; , and therefore cannot account for the Ca2 -sensitive portion of toxic Na influx observed in wheat. Recently, a second, putative low-affinity cation transporter LCT1 ; has been cloned from wheat, which catalyzes low rates of monovalent and divalent cation transport from millimolar salt solutions when expressed in yeast Schachtman et al., 1997; Clemens et al., 1998 ; . The physiological role of the protein and its mechanism of transport remain to be elucidated. Electrophysiological studies have suggested that Na influx into cereals is mediated by voltage-independent, nonselective cation channels. Studies of Na currents in the cortex of wheat Tyerman et al., 1997 ; , maize Roberts and Tester, 1997 ; , and suspension-cultured barley Amtmann et al., 1997 ; indicated that Na influx was predominantly via an instantaneous current of low selectivity among monovalent cations for review, see Amtmann and Sanders, 1999; Tyerman et al., 1999; White, 1999 ; . In wheat, this current had a permeability sequence for monovalent cations of Rb K calculated from and pyridium.
Affiliations: Department of Biology and Biochemistry, University of Houston, TX 77204-5001, USA ABSTRACT: Clostridium Botulinum neurotoxins BoNTs ; are zinc endopeptidases. They block the release of acetylcholine at neuromuscular junctions after entering the pre-synaptic neuron, resulting in the onset of progressive flaccid paralysis and ultimately death due to respiratory failure. BoNTs are released from bacteria as single chain polypeptides of ~150 kDa and are subsequently activated by proteases to generate di-chain toxins consisting of a heavy chain HC ; of ~100 kDa and a light chain LC ; of ~50 kDa. The LC is linked by a single disulfide bond to HC. The HS is responsible for binding of the toxin to the nerve terminal and for internalization of the LC into the cytosol. Each of the seven serotypes A-G ; of Clostridium Botulinum neurotoxin exert their action by cleaving specific components of the synaptic vesicle fusion machinery: Synaptobrevin VAMP for types B, D, F, and G ; syntaxin for type C and SNAP-25 for types A and E. Herein we present a structure-based pharmacophore design effort for Botulinum neurotoxin type B BoNT B ; using a static pharmacophore modeling method using an X-ray structure PDB code: 1EPW ; as well as a dynamic pharmacophore which is generated by mapping each binding pocket and overlaying all protein conformations from the MD simulation. The GRID program was used to extract molecular interaction fields MIFs ; for the catalytic domain of BoNT B. After identifying the energetically important interactions for the conserved binding regions, a pharmacophore model is defined in which the type of interaction and their geometrical relationships are directly read out from the GRID mappings. This pharmacophore model was used to extract new candidate inhibitors against cleaving SNARE proteins from the ACD database with the CATALYST program. Support: This work is supported by a grant from the National Institutes of Health NIAID AI055883 ; . Computer and software resources were provided by the Texas Learning and Computation Center, the University of Houston, and the Institute for Molecular Design. Presenter: Sangbae Lee.
With insomnia are well recognized. If Dalmane is to be com bined with other drugs having known hypnotic properties or CNS-depressant effects, due consideration should be given to additive effects. As with any hypnotic, patients should be cau tioned about driving, operating hazardous machinery or drinking alcohol during therapy and diclofenac.
Use during pregnancy The safety of rizatriptan for the use in human pregnancy has not been established. Animal studies do not indicate harmful effects at dose levels that exceed therapeutic dose levels with respect to the development of the embryo or fetus, or the course of gestation, parturition and postnatal development. Because animal reproductive and developmental studies are not always predictive of human response, MAXALT should be used during pregnancy only if clearly needed. 09: 50 10: To combat atherosclerosis, modulating inflammation is more important than lowering LDL Pros Cons Dr. Piyamitr Dr. Taworn and mestinon. Research investments through changes to policy and information systems.
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Capital expenditures of , 149, , 167, and , 587 for the years ended December 31, 2000, 2001 and 2002, respectively, are substantially utilized for contract manufacturing and branded pharmaceutical products purposes. 18. Related Party Transactions and pepcid. A 2001 study comparing four of the triptans concluded that Maalt and Zomig were more effective at relieving nausea associated with migraines than Imitrex or Amerge. Of course about a third to a half of the patients in the study got better in two hours based simply on the placebo effect.
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A few have not availed the loan The EDP training may precede facility even after receiving the selection of beneficiaries for EDP training. financial assistance. Out of the target group a certain number which is more than the target for the year could be identified for undergoing training without any commitment on the part of DMA regarding financial assistance after the completion of training. The bankers may consider viable proposals beneficiaries out of the above for financial assistance later.
Generic Maxalt3. Medication Regimen Review MRR ; Review for compliance with the MRR requirements at F428. Determine: If the pharmacist had identified and reported to the director of nursing and attending physician any irregularities with the medication regimen such as: o The emergence or existence of clinically significant adverse consequences; o Excess dose or duration, lack of monitoring, lack of indication for use, lack of GDR as indicated ; or behavioral interventions for residents receiving antipsychotics, medication interactions potentially affecting the medication's effectiveness; and. A 72-year-old man undergoes uneventful implantation of a ventricular inhibited VVI ; permanent ventricular pacemaker for treatment of symptomatic sinus node dysfunction. Two days later, he returns to the hospital complaining of recurrent dizzy spells and chest pain. The ECG shown in Figure 1 is recorded. He missed the birth of his first greati miss him a lot and buy cafergot. | Maxalt medication for migraine headachesStructural evaluation on the oligosaccharide components in the mixtures. Quantification and comparison of the molecular configurations between the heparin administered orally and the heparin administered intravenously and sc. Example, you may ask m hdha? What is this? ; and hear hdha maktab al-bard This is the post office ; in response. Or you may ask a yes-no question such as hal hdhihi Saydali'ya? Is this a pharmacy? ; , and hear kalla, hdhihi baqla No, this is a supermarket ; in response. Okay, now let's learn a bit more vocabulary and some useful prepositions that will make asking for directions and getting around much easier. Ready?.Network Health Preferred Drug List shaded items are effective 10 1 04 For updated information check network-health or call 888-257-1985 Metaproterenol Oral, 26 LOXITANE, 14 Metaxalone, 13 LOZOL, 16 Metformin, 29 LUDIOMIL, 13 Metformin, 29 LUMIGAN, 27 Meth Me Blue PA Salol ATP Hyos, 32 LUNELLE, 32 LUPRON, 23 METHADONE, 11 Methadone HCl, 11 LUPRON DEPOT, 23 LURIDE, 37 Methazolamide, 26 Methenamine Mandelate, 21 LUVOX, 13 LUXIQ, 35 METHERGINE, 32 Methimazole, 29 LYSODREN, 23 METHITEST, 30 Methocarbamol, 13 --M-- Methotrexate, 10, 23 Methoxsalen, 34 M.A.O. Inhibitor Agents, 13 Methyldopa, 16 MACROBID, 33 Methylergonovine Maleate, 32 MACRODANTIN, 33 Methylphenidate, 14 Macrolide Antibiotic Agents, 20 Methylphenidate, Extended Release, 14 MALARONE, 22 Methylprednisolone, 30 Malathion, 36 Methyltestosterone, 30 MANDELAMINE, 21 Methysergide, 11 Maprotiline, 13 METIMYD, 27 MARINOL, 18 Metipranolol, 27 MATULANE, 23 Metoclopramide, 18, 19 MAVIK, 15 Metolazone, 16 MAXAIR, 25 Metoprolol Succinate, 15 MAXAIR AUTOHALER, 25 Metoprolol Tartrate, 15 MAXALT, 11 METROGEL, 33 MAXALT mlT, 11 METROGEL-VAGINAL, 35 MAXIFLOR, 35 Metronidazole, 20, 35 MAXITROL, 26 Metronidazole Topical, 33 MAXIVATE, 35 MEVACOR, 17 MAXZIDE 25, 16 Mexiletine, 15 MAXZIDE 50, 16 MEXITIL, 15 MEBARAL, 12 MIACALCIN, 30 Mebendazole, 20 Miconazole, 35 Meclizine, 18 Miconazole Nitrate, 34 Meclofenamate, 10 MICONAZOLE OTC, 34 MECLOMEN, 10 MICRO-K, 36 MEDROL, 30 MICRO-K 10, 36 MEDROL DOSEPAK, 30 MICRONASE, 29 Medroxyprogesterone, 32 MIDAMOR, 16 Medroxyprogesterone Acetate Estradiol Cypionate, 32 Midodrine, 26 Medrysone, 27 MIDRIN, 10 Mefenamic Acid, 10 Miglitol, 29 Mefloquine, 22 Migraine Agents, 10 MEGACE, 23 MIGRANAL, 11 Megestrol, 23 MINIPRESS, 16 MELLARIL, 14 MINOCIN, 21 Meloxicam, 10 Minocycline, 21 Melphalan, 23 MINOXIDIL, 17 Memantine, 12 Minoxidil, 17 MENEST, 30 MINTEZOL, 20 Meperidine, 11 MIRALAX, 19 Mephobarbital, 12 MIRAPEX, 12 MEPHYTON, 37 MIRCETTE, 32 MEPRON, 22 Mirtazapine, 13 Mercaptopurine, 23 Miscellaneous Analgesics, 11 Mesalamine, 19 Miscellaneous Antibiotic Agents, 20 Mesna, 23 Miscellaneous Antidepressant Agents, 13 MESNEX, 23 Miscellaneous Anxiolytics, Sedatives, and Hypnotics, 14 MESTINON, 13, 33 Miscellaneous EENT Agents, 28 METADATE CD, 14 Miscellaneous Inhaled Agents, 28 METAGLIP, 29 Miscellaneous Injectable Agents, 24 Metaproterenol, 25 48. |
Despite the existence of an advanced, highly institutionalized U.S. medical system and availability of health professionals, many Asians and Asian Americans specifically, those in the separation and marginalization level of acculturation ; appear to have extremely low utilization of mental health services, compared to other U.S. populations. The Chinese American Psychiatric Epidemiological Study CAPES ; found that only 17% of those experiencing mental health problems sought care DHHS, 2001 ; . Similarly, in a small sample of Asian Americans who participated in the National Comorbidity Study NCS ; , less than 25% of those experiencing a mood or anxiety disorder had sought care DHHS, 2001 ; . Asians and Asian Americans may still prefer utilizing the traditional healing methods for physical health and emotional problems. Language is another significant barrier that many Asian immigrants face when they do seek mental health assistance. About 35% of Asians and Asian Americans live in households where there is limited English proficiency in those over age 13 USCB, 2003 ; . Shon and Ja 1982 ; indicated that.
1. In addition to utilizing a preferred agent when applicable, the number of tablets doses allowed per month is restricted on triptans as defined in the table on next page ; . 2. Only one prescription of triptans per month is allowed without a Prior Authorization, with the exception of Imitrex sumatriptan ; , for which one prescription each of the injectable form and the tablet or nasal is allowed. 3. Prior Authorization will not be given to patients with a history of ischemic heart disease. 4. The recipients profile must NOT contain an MAOI monoamine oxidase inhibitor Parnate, Marplan or Nardil ; if receiving Maxxalt rizatriptan ; , Imitrex sumatriptan ; or Zomig zolmitriptan ; . 5. Patients on Propanolol Inderal ; will not be granted authorization of Maxatl 10mg or Maxal 10mg orally distintegrating tablet only the 5 mg may be authorized.
Prescription Drug Limit Accutane 150 days supply per calendar year Accutane 30 days per prescription dispensed Actiq 120 lozenges per 30 days Advair Diskus 1 inhaler 60 blisters ; per 30 days Aerochamber 1 per calendar year Ambien tablets 30 tablets per 30 days Amerge 1 mg tablets 18 tablets 2 boxes ; per 30 days Amerge 2.5 mg tablets 9 tablets 1 box ; per 30 days Anzemet tablets 10 tablets per prescription dispensed Axert 12.5 mg tablets 12 tablets 2 boxes ; per 30 days Axert 6.25 mg tablets 18 tablets 3 boxes ; per 30 days Bextra 30 tablets per 30 days Caverject 6 injections per 30 days Celebrex 60 capsules per 30 days Cialis 6 tablets per prescription dispensed Clarinex 30 tablets per 30 days Crestor 30 tablets per 30 days Diabetic Test Strips, Lancets, Syringes 800 units per 3 month period Edex 6 injections per 30 days Elidel cream 30 grams per prescription dispensed Emend 5 tablets per prescription dispensed Erectile Dysfunction Medications Viagra, Cialis, Levitra ; Combined limit of 6 tablets per 30 days Foradil 1 inhaler 60 capsules ; per 30 days Frova 2.5 mg tabets 18 tablets 2 boxes ; per 30 days Imitrex 100 mg tablets 9 tablets 1 box ; per 30 days Imitrex 25 mg tablets 18 tablets 2 boxes ; per 30 days Imitrex 50 mg tablets 18 tablets 2 boxes ; per 30 days Imitrex injection 3 kits 6 injections ; per 30 days Imitrex Nasal Spray 12 sprays 2 boxes ; per 30 days Iressa 30 tablets per 30 days Ketek 20 tablets per prescription dispensed Kytril tablets 10 tablets per prescription dispensed Lamisil 90 days supply per calendar year Levitra 6 tablets per prescription dispensed Lipitor 30 tablets per 30 days Maxalt, Maxalt mlT 5 mg tablets 24 tablets 4 boxes ; per 30 days Prescription Drug Maxalt, Maxalt mlT 10 mg tablets Migranol Nasal Spray Muse Namenda Nexium Ortho Evra Oxycontin Pravachol Provigil 100 mg Provigil 200 mg Regranex Relpax 20 mg tablets Relpax 40 mg tablets Serevent Diskus Sonata tablets Spiriva Sporanox Stadol NS Strattera Terazol 3 Terazol 7 Toradol Tramadol Ultram Ultracet Viagra Vytorin Zetia Zocor Zofran ODT tablets Zofran tablets Zomig Nasal Spray Zomig, Zomig ZMT 2.5 mg tablets Zomig, Zomig ZMT 5 mg tablets Zovirax ointment Limit 12 tablets 2 boxes ; per 30 days 16 sprays 2 boxes ; per 30 days 6 inserts per 30 days 60 tablets per 30 days 30 capsules per 30 days 3 patches per 28 days 120 tablets per 30 days 30 tablets per 30 days 120 tablets per 30 days 60 tablets per 30 days 15 gm per prescription dispensed 12 tablets per 30 days 6 tablets per 30 days 1 inhaler 60 blisters ; per 30 days 30 tablets per 30 days 1 inhaler 30 capsules ; per 30 days 90 days supply per calendar year 2 bottles 2.5ml each ; per 30 days 60 capsules per 30 days 1 tube per 30 days 1 tube per 30 days 20 tablets per calendar year 240 tablets per 80 days 240 tablets per 30 days 6 tablets per prescription dispensed 30 tablets per 30 days 30 tablets per 30 days 30 tablets per 30 days 10 tablets per prescription dispensed 10 tablets per prescription dispensed 12 sprays 2 boxes ; per 30 days 12 tablets 2 boxes ; per 30 days 6 tablets 2 boxes ; per 30 days 30 grams 2x15gm tubes ; per 30 days.
You have the right to appeal this decision by asking for a review by the Medicare Appeals Council Appeal Level 4 ; . The letter you get from the ALJ will tell you how to request this review!
The Canadian pharmacy program, Minnesota Advantage Meds, makes available a limited formulary of drugs to state employees at no cost and is an optional enhancement to the basic pharmacy benefit plan offered through the Advantage Health Plan. With the changes in the basic pharmacy benefit plan and the introduction of the new pharmacy benefit manager, Navitus Health Solutions, there have been some corresponding changes in the limited formulary of drugs available through the Canadian pharmacy program. The existing three formularies formerly available through Advantage Meds have now been consolidated into a single limited formulary that will be the same for everyone regardless of the health plan in which the individual is enrolled. The enclosed two attachments show the revised Canadian formulary and the drugs that will no longer be available effective January 1, 2008. No new prescriptions will be accepted for drugs on the terminating list; however, refills will be allowed through the refill termination date shown on the attachment. The Canadian mail order pharmacy service was developed as part of Governor Pawlenty's plan to help reduce Minnesotans' expenses for prescription medicine. If you are an Advantage Plan member and your drug is on the formulary, I would encourage you to visit the Advantage Meds Web site advantage-meds ; to consider whether this valuable benefit would be a good option for obtaining maintenance prescription drugs at no cost. Sincerely. Products include Novartis' Migranal dihydroergotamine mesylate ; Nasal Spray and Cafergot caffeine and ergotamine ; tablets and suppositories: there are others. In 1991, Glaxo as it then was ; launched the first of the `triptans', Imigran sumatriptan ; , initially in the Netherlands and subsequently elsewhere. The drug is an agonist at vascular 5-HT1D receptors, which are localised in the basilar artery and in the vasculature of the dura mater where they mediate vasoconstriction. In addition, sumatr iptan appears to interact with 5-HT receptors on peripheral terminals of the trigeminal nerve, which innervate cranial blood vessels. Originally available in oral and injectable formulations, the product has now been widely launched throughout the world, including in intranasal and rectal for mulations, and is available in many countries without a prescription. Imigran Imitrex in some markets ; was followed onto the market by a number of other triptans, including Ortho-McNeil's Axert almotr iptan ; , Pfizer's Relpax eletriptan ; , Vernalis' Frova frovatriptan ; , GlaxoSmithKline's Amerge naratriptan ; , Merck & Co's Maxalt r izatr iptan ; , and AstraZeneca's Zomig zolmitriptan ; . Frova is marketed in the US by Endo Pharmaceuticals and in Europe by Menarini. The triptans have no use in preventing migraine attacks, but they are able to abort an attack once it has started. For this reason they are referred to as abortive migraine medications. However, recent research has shown that some tr iptans may be able to prevent migraine associated with menstruation. A study published in 2004 showed that women who took frovatriptan for six days, beginning two days before the anticipated start of menstrual migraine headache, had a much lower incidence of migraine, with more than half of them having no headache at all. Earlier this year, Vernalis completed further studies aimed at obtaining approval for the use of Frova as a short-term prevention of menstrual migraine, and Endo filed for the expanded indication with the US FDA in July. No other triptan is currently approved for this indication and Vernalis believes frovatriptan's long half-life make it a particularly appropriate treatment for this application. Approval of the menstrual migraine indication would tr igger a US million milestone payment to UK-based Vernalis. It should also boost sales of the product, which. II Which Triptan?-- Opportunity for Same or Better Outcomes at Lower Cost With 7 triptans on the market in the United States, there is considerable opportunity for managed care plans to negotiate significant price reductions from manufacturers for preferred formulary status, particularly under 3-tier benefit designs or in closed formularies i.e., 100% member cost-share for nonformulary drugs ; . Last year, the Department of Defense and Veterans Affairs released a request for price ; proposal from manufacturers of 4 triptans the newest triptan, eletriptan [Relpax], was apparently introduced after the RFP was prepared ; . The drugs under consideration by DOD VA were almotriptan Axert ; , sumatriptan Imitrex ; , rizatriptan Maxalt ; , and zolmitriptan Zomig ; , based, in part, on prices bid in an RFP in October 2002. The RFP found the 4 triptans to be therapeutically equivalent, based on "similar outcomes, similar side-effect profiles, and sufficient safety data."1 Naratriptan Amerge ; and frovatriptan Frova ; "should not be considered front-line agents" according to the VA "because of less favorable pain-free results at two hours as compared to the other triptans." On April 7, 2003, the comptroller general denied a protest from the manufacturer of sumatriptan that claimed "discrepancies in the meta-analyses" and alleged superiority of sumatriptan; the comptroller general said, "Even accepting that sumatriptan could be considered superior, the agency's determination that the differences between the drugs were not material for its purposes has not been shown to be unreasonable." In a previous article in this Journal, a meta-analysis showed that the number needed to treat to achieve 1 patient pain free at 2 hours was 3.2 patients for rizatriptan 10 mg, 4.2 patients for zolmitriptan 5 mg, 4.7 patients for either almotriptan 12.5 mg or sumatriptan 100 mg, and 5.9 patients for sumatriptan 50 mg. Naratriptan 2.5 mg required 8.2 patients, and frovatriptan 2.5 mg required 11.3 patients treated to achieve 1 patient pain free at 2 hours.2 In this issue of the Journal, Williams and Reeder found in their base-case analysis that the average cost-effectiveness ratios, using March 2004 prices, were , 3, and 8 per composite end point defined as Sustained pain-free and No Adverse Events SNAE ; for migraine attacks for almotriptan 12.5 mg, sumatriptan 50 mg, and sumatriptan 100 mg, respectively.3 In other words, sumatriptan had a price premium of 62% to 68% compared with almotriptan. The incremental cost-effectiveness ratios for almotriptan 12.5 mg were and compared with sumatriptan 50 mg and sumatriptan 100 mg, respectively ; per incremental attack at which SNAE is achieved. This research has significant value for managed care pharmacists by determining cost for the combined outcomes of efficacy and safety. Readers should note that this analysis by Williams and Reeder included the 67% price increase for almotriptan from .99 average wholesale price per unit to .44 per unit ; that was imposed in late 2003 when the drug was transferred from one manufacturer to another. II Does Member Cost Sharing Pose a Threat to Desirable Patient Outcomes? Cost sharing by health plan beneficiaries is on the way up, both.
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