New developments in drug therapy

Pamela Egan Practical Practitioner

 

By: Pamela Egan, FNP-C CDE

 

 

New developments in drug therapy

 

 

Dear Pam,

Does duct tape really work for wart removal?

It actually works for some patients. Tape occlusion seems to cause irritation and stimulate the immune system to attack the wart. Some dermatologists like duct tape because it’s so occlusive…and sticks so well. If you want to use the tried and true remedy, stick with salicylic acid.

If you want to try duct tape, cut a piece big enough to cover the wart. Leave it on for six days. Then take it off, soak the area in water and debride the wart with an emery board. Repeat this process until the wart goes away. Most patients notice a difference in two to three weeks. Stop using duct tape if the wart is unchanged after three weeks… or if it’s causing too much irritation.

There is a new medication being marketed for benign prostatic hyperplasia called Avodart (dutasteride). It’s being promoted as better than Proscar (finasteride) in its mechanism of action. It appears to lower dihydrotestosterone levels more than Proscar.

But it’s too soon to tell if Avodart actually improves outcomes. Avodart is priced similar to Proscar. Patients take one Avodart 0.5 mg soft-gel capsule daily. Because it is metabolized by the liver, watch for interactions with grapefruit juice, antifungals, antivirals, benzodiazapines, ciprofloxacin, cimetidine, etc.

Keep in mind that both Proscar and Avodart can take up to six months to work.

Now that Claritin (loratadine) is over the counter (OTC), many insurance plans will stop paying for some prescription antihistamines. They’ll say that since Claritin is over the counter, there’s no reason to pay for similar prescription antihistamines.

It’s the first non-sedating antihistamine to go over the counter. The over the counter version comes in the same strengths and formulations as the perscription version including Claritin-D, Redi-Tabs and syrup. Claritin will cost MUCH more than other OTC antihistamines… but about half as much as prescription Clarinex, Zyrtec or Allegra.

If you are currently using Benadryl or other sedating antihistamines, you may want to switch. Benadryl impairs driving about as much as alcohol.

Finally, Commit Lozenge is the newest OTC option to help smokers quit. The new lozenge works about as well as other nicotine products. But the lozenge is dosed differently.

It’s based on “time to first cigarette” instead of the number of cigarettes per day.

For patients who normally start smoking within 30 minutes of awakening, use the 4 mg lozenge. If they start more than 30 minutes after waking, use the 2 mg lozenge.

Patients suck lozenge every one to two hours for six weeks, every two to four hours for three weeks, then every four to eight hours for three weeks. It is important not to chew the lozenges.

Chewing them releases the nicotine too fast and can cause GI upset.

This article was originally published December 30, 2002 in The St. Tammany News.

 

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