New medicines
Mimpara
Composition: Cinacalcet (as hydrochloride).
Presentation: Film-coated tablets.
Class: Anti-parathyroid agent.
Indications: Treatment of secondary hyperparathyroidism in patients with
end-stage renal disease on maintenance dialysis therapy. May be used
as part of a regimen including phosphate binders and/or vitamin D sterols.
Reduction of hypercalcaemia in patients with parathyroid carcinoma.
Dosage: Secondary hyper-parathyroidism: Recommended starting dose 30mg
once daily. Mimpara should be titrated every two to four weeks to a maximum
dose of 180mg once daily
to a target parathyroid hormone (PTH) level of 150–300pg/ml. See
SPC. Parathyroid carcinoma: Recommended starting dose 30mg twice daily,
titrated every two to four weeks through sequential doses of 30mg twice
daily, 60mg twice daily, 90mg twice daily and 90mg three or four times
daily as necessary to reduce serum calcium concentration to or below
the upper limit of normal. See SPC.
Precautions: Mimpara should not be initiated in patients with a serum
calcium below the lower limit of the normal range. Adynamic bone disease
may develop if PTH levels are chronically suppressed. Mimpara should
be used with caution in patients with moderate to severe hepatic impairment,
or when being used concomitantly with strong inhibitors or inducers of
CYP3A4 or CYP1A2.
Side effects: Very common (>1/10) nausea, vomiting. Common (>1/100)
include anorexia, dizziness, paraesthesia, myalgia, asthenia, hypocalcaemia.
Legal category: POM.
Net price: 30mg 28 £126.28, 60mg 28 £232.96, 90mg 28 £349.44.
Contact details: Amgen, 240 Cambridge Science Park, Milton Road, Cambridge
CB4 OWD. Telephone 01223 420305.
Xagrid
Composition: Anagrelide hydrochloride.
Presentation: Opaque white hard capsules.
Class: Platelet lowering agent.
Indications: Reduction of elevated platelet counts in at-risk essential
thrombocythaemia patients who are intolerant to their current therapy
or whose elevated platelet counts are not reduced to an acceptable level
by their current therapy.
Dosage: Recommended starting dose 1mg/day, administered orally in two
doses of 0.5mg. The starting dose should be maintained for at least one
week, after which it may be titrated to the lowest effective dosage required
to maintain a platelet count below 600 x 109/L. The dosage increment
should not exceed 0.5mg/day in any one week and the single dose should
not exceed 2.5mg.
Precautions: The potential risks and benefits of anagrelide therapy in
a patient with mild or moderate impairment of hepatic function or with
impairment of renal function should be assessed before treatment starts.
Patients should be closely supervised clinically, including full blood
counts and assessment of liver and renal function.
Contraindications: Patients with severe hepatic impairment. Patients
with severe renal impairment (creatinine clearance <30ml/min).
Side effects: Very common (>1/10) headache. Common (>1/100) anaemia,
fluid retention, palpitations, tachycardia, nausea, diarrhoea, abdominal
pain, flatulence, vomiting, rash, fatigue.
Legal category: POM.
Net price: 0.5mg 100 £337.14.
Contact details: Shire Pharmaceuticals, Hampshire International Business
Park, Basingstoke, Hampshire RG24 8EP. Tel 01256 894000.
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