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There was no statistically significant difference in the ability of the niacin extended-release and simvastatin fixed-dose combination compared to simvastatin alone in achieving the National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol 110 goals based on 1 study sildenafil 100mg low cost. Achievement of National Cholesterol Education Program low-density lipoprotein cholesterol goals of fixed-dose combination products Fixed-dose combination LDL-C < 100 mg/dL or LDL-C < 70 mg/dL or product 2 buy sildenafil 75 mg on line. A comparative effectiveness review and meta-analysis was recently conducted by the Agency for Healthcare Research and Quality. Its conclusions regarding combination lipid- 115 lowering products are consistent with the results of this review. How do statins and fixed-dose combination products containing a statin and another lipid-lowering drug compare in their ability to increase high- density lipoprotein cholesterol? Summary of findings • When statins are provided in doses that reduce low-density lipoprotein cholesterol by equivalent amounts, a similar percent increase in high-density lipoprotein cholesterol can be achieved. Statins Page 31 of 128 Final Report Update 5 Drug Effectiveness Review Project • Some studies found greater increases in high-density lipoprotein cholesterol with low- dose rosuvastatin compared with atorvastatin, while other studies found no difference. Are there doses for each statin or fixed-dose combination product containing a statin and another lipid-lowering drug that produce similar percent increase in high-density lipoprotein cholesterol between statins? Statins A previous meta-analysis of placebo-controlled trials estimated that, on average, statins increased high-density lipoprotein cholesterol by 3 mg/dL (0. In our review of 77 head-to-head trials, statins raised high-density lipoprotein cholesterol levels from 0% to 19%, with the great majority between 5% and 9% (Evidence Table 1). While most found no significant difference in high- density lipoprotein cholesterol-raising among the statins, there were some exceptions. In 6 head-to-head studies of low-density lipoprotein cholesterol lowering, simvastatin 38, 41, 52, 55, 58, 68 increased high-density lipoprotein cholesterol more than atorvastatin 10 to 80 mg, 26, 29, 30, 39, 42, 48, but in 14 others, there was no significant difference between the 2 on this measure. Patients were then randomized to simvastatin 40 mg or atorvastatin 40 mg for 8 weeks, when the atorvastatin dose was increased to 80 mg while the simvastatin dose remained the same. The non-equivalent dosing and patient inclusion criteria limited the utility of this finding. There was 1 meta-analysis of randomized controlled trials of atorvastatin and simvastatin which demonstrated that simvastatin was generally associated with greater increases in high-density lipoprotein cholesterol than atorvastatin, with the greatest significance at the 12 higher doses of atorvastatin. Two studies that compared atorvastatin to simvastatin were designed to measure high- 33, 59 density lipoprotein cholesterol raising as a primary outcome. A 24-week study of 917 patients randomized to atorvastatin 80 mg or simvastatin 80 mg reported only an average of the 33 increase at weeks 18 and 24, separately, by baseline high-density lipoprotein cholesterol level. The average increase was the same in patients with baseline high-density lipoprotein cholesterol above and below 40 mg/dL: 2. These differences were not statistically significant. In the other study Statins Page 32 of 128 Final Report Update 5 Drug Effectiveness Review Project 59 reporting high-density lipoprotein cholesterol as a primary outcome, 826 patients were randomized to atorvastatin (20 mg daily for 6 weeks, then 40 mg daily) or simvastatin (40 mg daily for 6 weeks, then 80 mg daily) for 36 weeks. The primary endpoint was the average of results from weeks 6 and 12. The mean percent increase in high-density lipoprotein cholesterol was greater in the simvastatin group (9. High-density lipoprotein cholesterol increased by 9. At lower doses, the difference was not significant (percent change not reported). Nine head-to-head trials (in 11 publications) reported high-density lipoprotein cholesterol 14, 17, 20, 36, 43, 56, 69, 92-94, 98 increases with rosuvastatin compared with atorvastatin. Five studies reported greater increases in high-density lipoprotein cholesterol with rosuvastatin 5 or 10 mg 20, 36, 43, 93, 94 than with atorvastatin 10 mg. A sixth study of fair quality reported no difference 69 between the 2 drugs at the same doses. Two studies reported greater increases with rosuvastatin 10 mg than with atorvastatin 20 mg (with one showing a decrease in high-density lipoprotein 17, 98 cholesterol). Two studies reported greater increases with rosuvastatin 40 mg compared with 14, 20 atorvastatin 80 mg. Six head-to-head studies comparing low-dose rosuvastatin (5 or 10 mg) to low-dose atorvastatin (10 or 20 mg) reported no significant difference in change in high- 16, 21-24, 28, 91 density lipoprotein cholesterol.

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The side effects of conventional drug treatments for IBS/C cheap 100 mg sildenafil. Stephenson JJ generic sildenafil 100mg otc, Barghout V, Kahler KH, Fernandes J, Beaulieu JF, Joo S, et al. Effectiveness of tegaserod therapy on GI-related resource utilization in a managed care population. Long-term follow-up of medically treated childhood constipation. Tarpila S, Tarpila A, Grohn P, Silvennoinen T, Lindberg L. Efficacy of ground flaxseed on constipation in patients with irritable bowel syndrome. Current Topics in Nutraceuticals Research 2004;2(2):119-25. Thompson WG, Creed F, Drossman DA, Heaton KW, Mazzacca G. Functional bowel disease and functional abdominal pain. Tomas-Ridocci M, Anon R, Minguez M, Zaragoza A, Ballester J, Benages A. What is the most effective way for relieving constipation in children aged >1 year? Tytgat GN, Heading RC, Muller-Lissner S, Kamm MA, Scholmerich J, Berstad A, et al. Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. A comparative study: the efficacy of liquid paraffin and lactulose in management of chronic functional constipation. Biofeedback training in treatment of childhood constipation: a randomised controlled study. Constipation Drugs Page 90 of 141 Final Report Drug Effectiveness Review Project 109. Constipation and solitary encopresis; diagnostic work-up and therapy]. Management of constipation in residents with dementia: sorbitol effectiveness and cost. Management of constipation in residents with dementia: sorbitol effectiveness and cost. Macrogol 4000 in treatment of chronic functional constipation of aged patients. Chinese Journal of New Drugs and Clinical Remedies (China) 2004;23:101-03. Constipation Drugs Page 91 of 141 Final Report Drug Effectiveness Review Project EVIDENCE TABLES Constipation Drugs Page 92 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 32 ST U DY : A uth ors,article#: A ndorskyand G oldner Y ear: 1990 C ountry:U SA F U N DIN G : N R R ESEA R C H O B JEC T IV E: Com pareclinicalefficacyandsafetyof PE G 3350vs. Y ear: 1995 C ountry:U S F U N DIN G : Proctor& G am bleCo. N /A Duration: 8weeks 8weeks Samplesize: 11 11 IN C L U SIO N C R IT ER IA : Subjectivechronic constipation:definedaspassageof <= 3stools/weekforatleast6m onths;subjects entered4-wkbaselinephase,andonlythosewhowereconfirm edonbasisof stooldiariestodem onstrate constipationwererandom ized;fullym obile& healthyonbasisof m edicalhistory& physicalex am ;19- 85yrs. Y ear:1995 PO PU L A T IO N G roupssimilar atbaseline:N o,theydifferinsex anddurationof constipation C H A R A C T ER IST IC S: psyllium placebo M eanage(years): 52. Y ear:1995 R ESU L T S: H ealth O utcomeM easures: • Stoolfrequencyincreasedsignificantlyafter8wkspsyllium treatm ent(3. A dh erence/C ompliance: N R Constipation Drugs Page 98 of 141 Final Report Drug Effectiveness Review Project A N A L Y SIS: IT T :Y es Postrandomizationexclusions:N o A DEQ U A T ER A N DO M IZ A T IO N : N R A DEQ U A T EA L L O C A T IO N N R C O N C EA L M EN T : B L IN DIN G O F O U T C O M E yes A SSESSO R S: A T T R IT IO N (overall): O verallattrition: 0 Differentialattritionh igh : N o A T T R IT IO N (treatmentspecific): psyllium placebo T otalattrition: 0 0 W ith drawalsdueto adverseevents: 0 0 Q U A L IT Y R A T IN G : F air Constipation Drugs Page 99 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 43 ST U DY : A uth ors,article#:A ttar etal. F U N DIN G : N R R ESEA R C H O B JEC T IV E: Tocom paretheefficacyof PE G andlactuloseinchronic constipation DESIG N : Studydesign:singleblindR CT— asthetreatm entsdifferedinappearanceandtaste,patientsm ayknow whichtheyreceived Setting:M ulti-center, m ulticenter,10centersinF ranceandScotland,patientsrecruitedfrom outpatient gastroenterologyandgeriatric institutions Samplesize:115 IN T ER V EN T IO N : PEG 3350 (with electrolytes) lactulose Dose: 13. Y ear:2004 PO PU L A T IO N G roupssimilar atbaseline: Y es C H A R A C T ER IST IC S: PEG 3350 lactulose M eanage(years): 55 55 Patientsaged 65 yearsor older (% ): 41. Y ear:1999 A DV ER SEEV EN T S: PEG 3350 lactulose O veralladverseeffectsreported: N R N R M ediandailyepisodesof: • diarrhea 0. A dh erence/C ompliance: N R A N A L Y SIS: IT T :no Postrandomizationexclusions:N R A DEQ U A T ER A N DO M IZ A T IO N : yes A DEQ U A T EA L L O C A T IO N N R C O N C EA L M EN T : B L IN DIN G O F O U T C O M E D efacto“no”becausepatientsm ayhaveknownthedrug duetotaste/appearance,theoutcom eassessors A SSESSO R S: andprovidersm ayhavelearnedthataswell A T T R IT IO N (overall): O verallattrition: 13% Differentialattritionh igh :no A T T R IT IO N (treatmentspecific): PEG 3350 lactulose T otalattrition: 10 6 W ith drawalsdueto adverseevents: 2 1 Q U A L IT Y R A T IN G : Poor Constipation Drugs Page 102 of 141 Final Report Drug Effectiveness Review Project C h ronicC onstipationandIB S-C 33 ST U DY : A uth ors,article#: C leveland etal.

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Placebo-con trolledtrialsofharmsoutcomes Author Studydesign Year Settin g Eligibilitycriteria In terven tion s Run -in /washoutperiod! Placebo-con trolledtrialsofharmsoutcomes Methodofoutcome Age Numberscreen ed/ Author Allowedothermedication s/assessmen tan dtimin gofGen der Otherpopulation eligible/ Year in terven tion s assessmen t Ethn icity characteristics en rolled! Placebo-con trolledtrialsofharmsoutcomes Number withdrawn / Author losttofu/ Methodofadverseeffects Year an alyzed Outcomes assessmen t! NCS Page 339 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable13 cheap 75mg sildenafil visa. Placebo-con trolledtrialsofharmsoutcomes Totalwithdrawals; Author Adverseeffects withdrawalsduetoadverse Year reported even ts Commen ts! Placebo-con trolledtrialsofharmsoutcomes Author Studydesign Year Settin g Eligibilitycriteria In terven tion s Run -in /washoutperiod W'$% 12())( * +% cheap 100mg sildenafil,-. Placebo-con trolledtrialsofharmsoutcomes Methodofoutcome Age Numberscreen ed/ Author Allowedothermedication s/assessmen tan dtimin gofGen der Otherpopulation eligible/ Year in terven tion s assessmen t Ethn icity characteristics en rolled W'$% 12())( L* _8- : 7# 12. Placebo-con trolledtrialsofharmsoutcomes Number withdrawn / Author losttofu/ Methodofadverseeffects Year an alyzed Outcomes assessmen t W'$% 12())( S)I=(I==) A$+% 2X$/;# 72A$+<38$. Placebo-con trolledtrialsofharmsoutcomes Totalwithdrawals; Author Adverseeffects withdrawalsduetoadverse Year reported even ts Commen ts W'$% 12())( * $6- 872-? F 2X$+,+"# $F2C 2Z8- % "# /7/1% c u taneou s h ydroc ortisone with in onem onth of th efirst prestu dystadiom etry m easu rem ents andevidenc eof m alnu trition. Ho lm yes Notc lear no fair NR /NR /42 seriou s oru nstab ledisease, 4-week plac eb o ru n- 1998 infec tion of th eu ppreandlower in Neth erlan ds respiratorytrac t,stru c tu ral ab norm alities orintranasal sym patic om im etic th erapy, preg nantorlac tating wom en. Sko n er No yes no fair NR /NR /100 Patients taking m edic ations Wash ou tperiods for 2000 known to affec tg rowth du ring th e m edic ations known stu dy to affec tg rowth were estab lish ed,b u tnot reportedin ab strac t NCS Page 350 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable14. Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es Class Auth o r, n aïve Co n tro l g ro up Year patien ts stan dardo f Co un try o n ly care Fun din g Relevan ce Allen no yes GlaxoSm ith Kline yes 2002 su pportedstu dy U SA Ho lm no yes financ ialsu pport yes 1998 from Glaxo VB, Neth erlan ds Th eNeth erlands Sko n er no N/A NR yes 2000 NCS Page 351 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable14. Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es InternalValidity Repo rtin g o f attritio n , Auth o r, Allo catio n Elig ibility Outco m e cro sso vers, Year Ran do m iz atio n co n cealm en t Gro upssim ilarat criteria assesso rs Carepro vider Patien t adh eren ce,an d Co un try adequate? Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es ExternalValidity Lo ssto fo llo w-In ten tio n - Auth o r, up: to -treat Po st- Num berscreen ed/ Year differen tial/h i(ITT) ran do m iz atio n Quality elig ible/ Co un try g h an alysis exclusio n s Ratin g en ro lled Exclusio n criteria Run -in /wash o ut Sch en kel no yes no fair NR /NR /98 Nonereportedin ab strac t Wash ou tperiods for 2000 m edic ations known Abstract to affec tg rowth were estab lish edb ased on estim atedperiod of effec tandth ese m edic ations were proh ib iteddu ring th e stu dy,b u tnot reportedin ab strac t. Sh ortc ou rses os eith eroral prednisonelasting no long erth an 7dor low-potenc ytopic al derm atolog ic al c ortic osteroids lasting no long er th an 10dwere perm ittedif nec essary NCS Page 353 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable14. Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es Class Auth o r, n aïve Co n tro l g ro up Year patien ts stan dardo f Co un try o n ly care Fun din g Relevan ce Sch en kel no N/A NR yes 2000 Abstract NCS Page 354 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable14. Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es InternalValidity Repo rtin g o f attritio n , Auth o r, Allo catio n Elig ibility Outco m e cro sso vers, Year Ran do m iz atio n co n cealm en t Gro upssim ilarat criteria assesso rs Carepro vider Patien t adh eren ce,an d Co un try adequate? Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es ExternalValidity Lo ssto fo llo w-In ten tio n - Auth o r, up: to -treat Po st- Num berscreen ed/ Year differen tial/h i(ITT) ran do m iz atio n Quality elig ible/ Co un try g h an alysis exclusio n s Ratin g en ro lled Exclusio n criteria Run -in /wash o ut Cutler no no (~7% no fair NR /NR /56 Historyof anydisorderth atm ig h t NR 2006 exc lu ded interferewith stu dyevalu ation;any from final loc alorsystem ic infec tion w/in 4 analysis) weeks of stu dy;UR TIw/in 6 weeks of stu dy;u seof presc riotion orOTCdru g s oth er th an forAR w/in 2weeks of stu dy; u seof anyinvestig ationaldru g w/in 30days of stu dy;u seof IM c ortic osteroids w/in 1yrororalor orallyornasalinh aled c ortic osteroids w/in 6m os of stu dy;m u ltipledru g allerg ies or c ortic osteroidallerg ies;positive h ep Bsu rfac eantig en orC antib odytest NCS Page 356 of 357 Final Report Update 1 Drug Effectiveness Review Project Eviden ceTable14. Quality assessm en to fplacebo -co n tro lledtrialso fh arm so utco m es Class Auth o r, n aïve Co n tro l g ro up Year patien ts stan dardo f Co un try o n ly care Fun din g Relevan ce Cutler no yes Sc h ering Plou g h yes 2006 NCS Page 357 of 357 . Reports are not usage guidelines, nor should they be read as an endorsement of or recommendation for any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Original Report: November 2004 Update 1: April 2006 The literature on this topic is scanned periodically. Update 2 prepared by: Susan Carson, MPH Nancy Lee, PharmD Sujata Thakurta, MPA:HA Drug Effectiveness Review Project Marian McDonagh, PharmD, Principal Investigator Oregon Evidence-based Practice Center Mark Helfand, MD, MPH, Director Oregon Health & Science University Copyright © 2010 by Oregon Health & Science University Portland, Oregon 97239. Final Report Update 2 Drug Effectiveness Review Project The medical literature relating to this topic is scanned periodically. Prior versions of this report can be accessed at the DERP website. Antihistamines Page 2 of 72 Final Report Update 2 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION.......................................................................................................................... For outpatients with seasonal or perennial allergic rhinitis or urticaria, do newer antihistamines differ in effectiveness?...................................................................................................

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