As the 2009/2010 influenza season progresses, there is cause for worry. Flu activity is already widespread in 46 states, according to the Center for Disease Control (CDC), and the 2009 novel H1N1 flu virus, popularly known as the “swine flu,” is on the rise. Meanwhile, the swine flu [...]]]>

As the 2009/2010 influenza season progresses, there is cause for worry. Flu activity is already widespread in 46 states, according to the Center for Disease Control (CDC), and the 2009 novel H1N1 flu virus, popularly known as the “swine flu,” is on the rise. Meanwhile, the swine flu vaccine is difficult to obtain, leaving many unprotected from this new strain. Fortunately, the antiviral treatments Tamiflu and Relenza are still largely effective against the swine flu.

Why is there so much worry about pandemic flu this year? Regular flu kills 36,000 people in the US each year, but the swine flu variation has the potential to kill many more. The latest update from the CDC shows that swine flu has caused at least 95 children’s deaths since April. Why is this strain so dangerous?

• It is a new combination (made of human, swine, and avian elements) and virtually no one has natural immunity to it
• The vaccine is not yet widely available
• This strain attacks the young and healthy population in disproportionate numbers

There is some hopeful news from the CDC in terms of protecting yourself:

Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Influenza antiviral drugs are prescription drugs (pills, liquid, or inhaler) that decrease the ability of flu viruses to reproduce. It is advised that you begin them within two days of getting influenza. Many people ask about taking anti-viral drugs before they show symptoms, but according to the CDC, pre-exposure antiviral chemoprophylaxis should only be used in limited circumstances, and in consultation with your doctor.

The drug oseltamivir (trade name Tamiflu, from Roche) is one of two drugs that is approved for treatment of swine flu. It is taken orally, in a pill form or a suspension. Common side effects include: nausea, vomiting, diarrhea, abdominal pain, and headache. Less frequently, delirium, hallucinations, rash, hepatitis, and allergic reactions including anaphylaxis can occur. There is some concern that oseltamivir can cause the desire to self-harm, and this seems more pronounced in children. People with the flu, particularly children, may be at an increased risk of self-injury and confusion shortly after taking Tamiflu and should be closely monitored for signs of unusual behavior. However, oseltamivir is approved by the FDA for use in children 1 year of age or older. In addition, in July 2009, the FDA issued an Emergency Use Authorization for the use of Tamiflu in pediatric patients younger than 1 year of age.

The drug zanamivir (trade name Relenza, from GlaxoSmithKline) is the other medication approved to treat swine flu. It is an inhaled powder that comes with a disk inhaler. It can cause side effects, especially in those with asthma or other chronic lung disease. Decreased respiratory function and bronchospasm have been reported with use of zanamivir. Zanamivir is generally not recommended for use in persons with underlying lung disease such as asthma and chronic obstructive pulmonary disease. Other side effects reported by less than 5% of those who have used this drug are diarrhea, nausea, sinusitis, nasal infections, bronchitis, cough, headache, and dizziness. Relenza is approved for treatment in children 7 years and older, but only those without underlying respiratory or heart disease, including asthma.

One final caution as you navigate flu season is to beware of some unscrupulous online vendors selling fake flu drugs to capitalize on the public’s fear. The Food and Drug Administration recently issued a warning to consumers to be careful not to purchase counterfeit medications. You may rest assured that eDrugSearch.com deals only with reputable, licensed pharmaceutical suppliers in the U.S. and Canada. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more. We offer a feedback system so consumers can share their ratings of the pharmacies they deal with. Browse the ratings, and enjoy peace of mind as you choose among our consumer-tested pharmacy partners for your flu season needs.

Earlier this month, a closely-watched trial over the osteoporosis drug Fosamax ended in mistrial, to the frustration of nearly everyone involved. The trial was marked by great tension, with a deadlocked jury, reports of threats of physical violence, and a judge-ordered cooling-down period.

What could [...]]]>

Earlier this month, a closely-watched trial over the osteoporosis drug Fosamax ended in mistrial, to the frustration of nearly everyone involved. The trial was marked by great tension, with a deadlocked jury, reports of threats of physical violence, and a judge-ordered cooling-down period.

What could cause such intense drama? Well, this was just one of approximately 900 state and federal cases pending against Fosamax, alleging that that medication causes osteonecrosis of the jaw (the death of jawbone tissue). In large part, the tension in the Manhattan courtroom was that this trial — the first — was supposed to be an indicator of how these hundreds of similar cases might proceed. The other major factor is that it is notoriously difficult to “prove” drug-related injuries, and this difficulty was definitely shown in the frustration and tension among jury members.

Millions of women have taken Fosamax (alendronate), a Merck drug that was approved in 1995 to treat osteoporosis associated with menopause, and in 1997 to prevent osteoporosis itself. Until the recent introduction of some competing medications, it was one of the most popular drugs in the U.S. It is still prescribed millions of times per year to women suffering from bone loss.

In short, Merck’s defense on this topic is that there is no definitive evidence that Fosamax causes the death of jaw tissue, while plaintiffs and their lawyers insist that Merck overpromoted Fosamax without warning doctors about the potential for jaw injury. Obviously, no conclusions were reached.

Of course, this is of great interest to women who may have taken, or are considering taking, Fosamax. Only your doctor can decide what is the right choice for you, but we thought we would enumerate the other medications available for treating osteoporosis for those doing research on Fosamax alternatives. One very important thing to be aware of it is that Fosamax is not the only osteoporosis drug in this class (the bisphosphonates), which all have a similar mode of action. Fosamax is being talked about most in the media, but all are associated with some amount of risk of damaging the jaw.

If you do choose to take a bisphophonate, know these facts:

• A high proportion of jaw injuries occur following high-dose intravenous administration, so that is a particularly risky way to take the medication.
• As many as 60% of the cases are preceded by a dental surgical procedure involving the jaw. In short, women who are expecting major dental work should consider delaying treatment with Fosamax, Boniva, Actonel or similar drugs until after their dental surgery.

Here are the main alternatives on the market for Fosamax:

1. Actonel (risedronate) is a bisphosphonate manufactured and marketed by Procter & Gamble and Sanofi-Aventis. It belongs to the same family of drugs as Fosamax, and may be associated with the same jaw side effects.
2. Boniva (ibandronate) is also a bisphosphonate, manufactured and marketed by GlaxoSmithKline and Roche Laboratories. It is a competitor to Fosamax, and may also affect the jaw tissue.
3. Evista (raloxifene) is NOT a bisphosphonate , but rather an oral selective estrogen receptor modulator from Eli Lilly and Company that affects bones through estrogen. Evista may be an interesting alternative for women concerned about their jaw health or planning oral surgery.

Also this month, The Wall Street Journal published an article called “From the Osteoporosis Front, Updates on Potential New Drugs.” These are the up-and-comers in clinical trials and going before the FDA. The story covers the latest news about Wyeth’s Viviant, Pfizer’s Fablyn, Amgen’s denosumab, and other upcoming treatments for osteoporosis.

If you are interested in following the Fosamax case that ended in a mistrial, it is expected to be re-tried in the spring. The name of the case is “In re Fosamax Products Liability Litigation, U.S. District Court, Southern District of New York (Manhattan), No. 06-1789.”