E-DRUG: Electronic Update 1 for Untangling the Web 11th Edition
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Dear Colleagues,
At the bottom of this message, you will find a link to both the Electronic
Update for the 11th Edition of Untangling the Web of antiretroviral price
reductions: a pricing guide for the purchase of ARVs for developing
countries, and the document itself, prepared by Médecins Sans Frontières,
Campaign for Access to Essential Medicines.
The Untangling the Web document was first published in response to the lack
of transparent and reliable information about prices of pharmaceutical
products on the international market. The purpose of the document is to
provide information to help purchasers make informed decisions when
purchasing ARVs. The report is a pricing guide and can not be viewed as a
manufacturers' price list.
Drug by drug, the report details the prices of ARVs quoted by companies,
both originator and generic manufacturers. It provides an analysis of the
evolution in the prices since the first edition and focuses on some of the
key access issues for each product in developing countries.
The objective of the electronic update is to have a flexible way of
including all the new information on products and prices in real time and
will be posted every time new information is obtained from companies. The
Untangling the Web document will continue to be updated and published
annually.
Electronic Update:
http://www.msfaccess.org/fileadmin/user_upload/diseases/hiv-aids/Electronic%20Update%20%201%20%20UTW%2011th%20Ed%20Jan%202009.pdf
English Version; Untangling the Web 11th Edition:
http://www.msfaccess.org/fileadmin/user_upload/diseases/hiv-aids/Untangling_the_Web/Untanglingtheweb_July2008_English.pdf
Kind regards,
Janice
Janice S.F Lee
Pharmacist
Médecins Sans Frontières
Campaign for Access to Essential Medicines
Phone: +41 22 84 98 407
e-mail: janice.lee@geneva.msf.org
www.msfaccess.org
E-DRUG: Literature on missed ARV doses
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Dear Colleagues,
I am looking for literature that could guide counseling of patients on Anti-retroviral Therapy with regards to missed/forgotten doses especially now that most of ARV medicines now come as Fixed Dose Combinations.
Question:
If the patient is to take the missed pill, what is the cut off time from the missed dose OR to the next dose?
Best regards,
Mathew N Maisiri
Pharmacy Coordinator
Directorate: Special Programs
MoHSS, Namibia
+264612032863
matmaisiri@yahoo.com
E-DRUG: Literature on missed ARV doses (2)
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Hello,
The issue of missed ARV dosses is a big challenge in the management of HIV/AIDs clients. The effective way to minimize or overcome this challenge is through continuous medication adherance counselling on every clinic visit and also following the SOP on dispensing process through Pharmacy best practice.
Timing for the next dose is very important in order to prevent unwanted drug effect. For adult client the missed dose should be taken immediately when realised if the duration is not morethan "6hours" and for paediatric client should not be morethan "2hours". Taken after those timing is more or less doubling the doses and could lead to unwanted effects of the respective drugs.However if a client missed ARV for morethan 6hours or 2hours as the case may be should wait for the next timing of next dose.
Medication adherance counseling will help to prevent drug resistance and tratment failure in the management of HIV/AIDs clients.
You can get more information from a book compiled by Howard university Pharmacists and continue education under the Global HIV/AIDS Initiative in Nigeria, Pharmaceutical care of HIV/AIDS clients for Community Pharmacists.
Regards,
Pharm.Mohammed Habeeb
Kano. Nigeria.
pharmhabeeb@yahoo.co.uk
E-DRUG: Literature on missed ARV doses (3)
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Unfortunately, it is hard to find clear and general advice for patients on what to do about missed ARV doses. This is, I think, related to the fact that patients can be on a variety of treatment regimens and each set of ARVs can have different pharmacokinetic characteristics. Also, most adherence advice concentrates very much on emphasising the essential need for near-perfect adherence in order to avoid the risk of drug-resistant virus taking over. And all patients should be strongly encouraged to get personal advice from their physician on how to deal with their ARV treatment, including missed doses and side effects.
However, the latest British HIV Association (BHIVA2008) guidelines say the following in section 11 on adherence:
"Practical steps to reduce barriers to adherence (such as low mood, fear of disclosure, substance misuse and drug intolerance) and simplify regimens remain important. An encouraging approach is likely to be more successful than an expectation of perfect adherence, which may reduce disclosure and drive patients to stop treatment completely. Medication with a long elimination half-life may be more forgiving of late or sporadically missed doses and patients should be advised always to take rather than skip late doses."
- in other words, patients on twice or once daily ARV doses should take a missed/late dose as soon as they remember it and then take the next dose at their usual time, so that they continue with their usual dosing schedule. But I would add that if someone is still in the early weeks of treatment and experiencing transient side effects such as nausea, vomiting or bowel disturbances, then taking two doses close together could make the side effects worse and, if there is only a short time to go before the next scheduled dose it might be better to wait. Under-dosing of HIV with ARVs carries a risk of developing drug-resistant HIV. Over-dosing with ARVs risks increased side effects, especially if there is a long elimination half-life. So as I said at the beginning - each patient and their ARV regimen might react differently, and it is essential to have guidance from a physician. And very high levels of adherence (no more than three missed doses per month if one is on twice-daily triple therapy) are absolutely essential to get the immune system back into working order and keep it there!
The BHIVA guidelines can be found at http://www.bhiva.org/files/file1030835.pdf (see page 591)
Carolyn GreenIndependent consultant - health & development
Registered pharmacist
cgreenconsult@hotmail.com
skype: cgreenconsult
tel: +44 1273 738 998cell: +44 7733 112 368