E-DRUG: rationale of dexamethasone combination? (8)
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Dexamethasone is not recommended in RA because of its long half life
compared to prednisolone and because Rx is likely to be over long periods
of time. The risk of NSAID induced GI damage is enhanced in the presence of
corticosteroids. Indomethacin should be dosed tds or minimally, bd both of
which regimens are inappropriate for a glucocorticoid - morning doses of
short half life glucocorticoids are preferred. The grounds for potential
approval of a combination product in the EU and also Australia (which
follows the EU position) is that there should be a proven advantage of the
combination over the use of the individual ingredients. As noted above,
there are only disadvantages of combining indomethacin with dexamethasone.
Finally, dose adjustment would be very difficult. This proposed combination
should be strongly opposed.
Rick Day
Richard DAY, MD FRACP
Professor of Clinical Pharmacology & Director Clinical Pharmacology &
Toxicology,
St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia, 2010
Tel: 61-(0)2-9361-2331 Fax: 61-(0)2-9361-2724
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