Ticlopidine’ s manufacturer notes that 8% of patients taking the drug develop this problem, and in one trial 4 out of 9599 patients taking clopidogrel developed severe neutropenia. 54.5% feared negative side effects 54.5% did not wish to take this kind of drug and tegaserod. How important is innovation in your activities? Marc Wiers: The key driver of our pharmaceutical company is to provide new solutions for patients that significantly contribute to curing diseases, thereby improving the quality of life. The successful quest for innovative, highly efficient, new products to address specific unmet therapeutic needs of patients is core to its "raison d'tre". Innovation is of paramount importance for a bio- pharmaceutical. PHARMACOPEIAL FORUM VOL. 33 NO. 3 MAYJUNE 2007. And excellent basilar artery patency, with no residual stenosis. The distal clot located at the junction of the left P1 and superior cerebellar artery was no longer present. Twenty minutes later, a second control angiogram confirmed the excellent anatomic result Figs. 1D and 1E ; . The proximal margin of the stent extended 1 mm into the left vertebral artery, covering the right vertebral artery outflow; however, its patency was not impaired Fig. 1D ; . No complications occurred during or after the stent deployment. For 3 days after the operation, a full dose of heparin was administered. The femoral sheath was left in place for 24 hr to enable immediate arterial access in case of neurologic deterioration. The same day, 250 mg of aspirin and 500 mg of ticpopidine were administered and continued for 6 months. The patient was discharged from the hospital 4 days after the procedure. He still suffers from the sequels of his second ischemic attack, but no new neurologic symptoms have developed. At the 7-month follow-up examination, the control angiogram showed excellent patency of the basilar artery Fig. 1F. Few broad-spectrum antibiotic agents are currently in development, " the company said in a statement. "Antibiotic development has slowed to the point that FDA has had few opportunities to approve new agents. In fact, development and approvals of new antibacterial agents have decreased by 56 percent over the past 20 years." Although new antibiotics have been few and far between, the use of existing drugs has grown markedly in both human medicine and to treat and promote the growth of farm animals. Because bacteria will eventually grow resistant to any antibiotic they encounter frequently, the pool of resistant bacteria is expanding fast. Schell, who spoke on a Wyeth teleconference but said he had no relationship to the company, said Tygacil is especially welcome because it can defeat a number of broadly resistant bacteria such as methicillin-resistant Staphylococcus aureus , and because it is effective against a wide range of bugs, including E. coli . "It's important to get the right antibiotic because if you don't choose right the first time, the patient does poorly, " he said. It can take one to two days of laboratory work to determine exactly what bacteria is causing an infection. The company said it is exploring other uses for the drug, including fighting pneumonia and some pediatric infections The Washington Post E XERCISE-INDUCED A STHMA M ORE C LEARLY L INKED TO H IGH-S ALT D IET An Indiana University professor may have uncovered the mechanisms by which high-salt diets can trigger exercise-induced asthma, offering the most complete picture to date of how dietary factors can both aggravate and alleviate the symptoms of this common condition. The study by exercise physiologist Timothy Mickleborough and his research team in IU Bloomington's Department of Kinesiology demonstrated for the first time that modifying salt intake for two weeks alters airway inflammation and the flow of oxygen into the bloodstream, termed the diffusion capacity of the lungs. "These findings show that modifying your diet has the potential to modify a disease state, " Mickleborough said. The findings appear in the June issue of Medicine & Science in Sports & Exercise, and Mickleborough presented them on June 3 at the annual conference of the American College of Sports Medicine in Nashville, Tenn. Exercise-induced asthma, also called exercise-induced bronchoconstriction, is a condition in which vigorous physical activity triggers an acute narrowing of the airway afterward, making breathing difficult. Up to 90 percent of people with asthma have EIA, in addition to as much as 10 percent of the general population without asthma and more than 10 percent of elite athletes. EIA typically is treated with medications, some of which are banned in international competition. The randomized, double-blind, crossover study involved 24 people with physician-diagnosed asthma and EIA. Study participants on the low-salt diet consumed 1, 446 milligrams of. One of the major developments last year, was the beginning of the Centralized Drug Purchase. The CDP involves centralizing pharmacy purchases for both EHA hospitals and other partner hospitals. The main objectives of the CDP is: to have a simple, consolidated and transparent drug procurement process which yields significant benefits for the organization and units both by reducing cost and improving services; uniform distribution of generic medicines; reduce the cost of medicines to the patients; and to ensure regular quality assurance through random sample testing with the government approved labs. The first order through CDP was placed for 12 items. In the first phase, 14 EHA hospitals and eight partner hospitals will get these drugs. In the coming years 35 items will be covered. We are in the process of, because polymorph. E, Douste-Blazy L, Maffrand JP: Broad spectrum anti-platelet activity of ficlopidine and PCR 4099 involves the suppression of the effects of released ADP. Thromb Res 48: 403-415, 1987.

Licensed indication considered `Prevention of atherothrombotic events in patients suffering from myocardial infarction from a few days until less than 35 days ; , ischaemic stroke from 7 days until less than 6 months ; , or established peripheral arterial disease.'1 This verdict applies to the use of clopidogrel for secondary prevention only. Refer to VS 02 for MTRACs recommendation on clopidogrel in combination with aspirin for patients with acute coronary syndrome. Background information Atherosclerotic vascular disease is the underlying cause of coronary heart disease e.g. angina, acute coronary syndrome [ACS], myocardial infarction [MI] ; , stroke, and peripheral vascular disease.2 Antiplatelet therapy in secondary prevention is known to reduce the incidence of non-fatal ischaemic stroke and myocardial infarction by about one third and vascular death by about one sixth in high-risk patients.3, 4 Current treatment options The most widely used antiplatelet agent is aspirin, but aspirin is not suitable for all patients as it exerts a dosedependent side-effect on the gastrointestinal tract, and a small proportion of patients may be hypersensitive to, or intolerant of aspirin. Other antiplatelet drugs include clopidogrel, ticlopidjne and dypiridamole. Sustained release dipyridamole is indicated for the secondary prevention of ischaemic stroke and transient ischaemic attacks TIA ; , with or without aspirin. T9clopidine is indicated for the prophylaxis of major ischaemic events in patients with history of ischaemic stroke, reversible neurological deficit, or TIA, and in patients with intermittent claudication. Dosage and administration For the secondary prevention of atherothrombotic events, clopidogrel is taken as a single daily dose of 75mg with or without food. Clinical efficacy A pivotal randomised controlled study CAPRIE ; evaluated the use of clopidogrel in patients with recent ischaemic stroke, recent MI or peripheral arterial disease.5 In this blinded trial, 19, 185 patients with a history of symptomatic atherosclerotic disease were randomised to treatment with clopidogrel 75mg day n 9599 ; or aspirin 325mg day n 9586 ; . Patients were followed up for 1-3 years mean 1.91 years ; equivalent to 36, 731 patientyears at risk. The primary endpoint of the CAPRIE trial was an intention to treat analysis of the first occurrence of an event in the outcome cluster of ischaemic stroke, MI or vascular death. In the clopidogrel group there were 939 atherosclerotic events during 17, 636 patient-years at risk, an average rate per year of 5.32%. In the aspirin group there were 1021 events during 17, 519 patient-years at risk, an average rate per year of 5.83%, relative risk reduction RRR ; 8.7% 95% CI 0.3-16.5 ; in favour of clopidogrel p 0.043 ; . Sub-group analysis suggested that the slight statistical significance seen in the primary efficacy analysis was mainly related to patients with peripheral arterial disease. However, the study was not powered to detect differences in effect between the clinical subgroups of patients. There were no significant differences between aspirin and clopidogrel in relation to the risk of death from any cause. Clopidogrel provides an additional 8.7% relative-risk reduction over and above the 25% reduction generally provided by aspirin. In a patient population similar to that in CAPRIE, aspirin would be expected to prevent about 19 major clinical events vs 24 with clopidogrel for each 1000 patients treated for 1 year. Calculating the NNT from the CAPRIE data, it would be necessary to use clopidogrel instead of aspirin in approximately 200 patients for 1 year to avert one additional major clinical event. Adverse effects In the CAPRIE study a similar number of patients in each group 11.4% ; withdrew permanently due to an adverse experience. Significantly more patients in the clopidogrel group withdrew due to rash than with aspirin p 0.05 ; , whereas significantly more patients in the aspirin group withdrew due to indigestion, nausea and vomiting, and gastrointestinal haemorrhage p 0.05 ; . Table 1 shows the proportion of patients reporting adverse events during the CAPRIE study. Although gastrointestinal irritation and haemorrhage led to withdrawal in significantly more patients taking aspirin than clopidogrel, it should be noted that the daily dose of aspirin used was 325mg. The rates of withdrawal could be expected to be less in a cohort of patients taking a lower antiplatelet dose of aspirin ie. 75mg or 150mg daily.
Table 2. Reasons for medication changes at the geriatric day clinic % of total discontinued or total started medication.

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